2014 Capstone Teams

Title: Improving Point-of-Care Diagnosis of Hematuria
Client: Thomas Chi, MD, Assistant Professor, Department of Urology, UCSF School of Medicine
Team: Ariel Wang, Hong Joo Kim, Prithvi Bomdica

Purpose:
Hematuria, the presence of red blood cells in urine, is a marker for a variety of pathological conditions such as urethritis, urinary tract infection, kidney stones, enlarged prostate, and cancers of the bladder, prostate, and kidney.  Asymptomatic microscopic hematuria occurs in up to 21% of the population. In a study of over-50 men, 70% of subjects who presented with hematuria were also diagnosed with pathological conditions. While gross hematuria is apparent in a urine sample due to the red color, microscopic hematuria must be diagnosed using dipstick tests or urinalysis through microscopy. The dipstick point-of-care (POC) products are inaccurate and require follow-up testing. Due to the necessity to source urine samples to a laboratory for accurate urinalysis, the diagnostic process is very time consuming. This project seeks to develop an inexpensive, time-efficient POC system capable of isolating red blood cells from a urine sample in order to accurately diagnose microscopic hematuria.

hematuria

http://www.rehcfl.com/wp-content/uploads/2013/05/hematuria.jpg


Title: Low-Cost 3D Retinal Imaging Device for Clinical Use
Client: Michael Ward, MD, PhD, Assistant Professor of Neurology & Opthamology, UCSF School of Medicine
Team: Jon Silberstein, Connor Ludwig, Deepika Bhatnagar, Sahithi Rani

Purpose:
The retina is vital to the diagnosis of optical conditions; however, and perhaps more interestingly, the retina has the proven ability to indicate other physiological conditions. For example, swelling of the optic nerve head has been associated with optic neuritis, malignant hypertension, papilloedema, and glaucoma. Papilloedema, specifically, is often present in cases of head trauma. The potential to detect or monitor papilloedema through retinal health would be a great asset to the clinical field. However, Optical Coherence Tomography machines, the current gold standard for retinal imaging, are prohibitively expensive. In order to determine the efficacy of using retinal imaging to detect or monitor papilloedema in clinical environments such as a physician’s office or emergency room, an alternative imaging solution is needed. This project seeks to develop a device that enables 3D retinal imaging in non-optometry clinical settings.

retina

http://eyepathologist.com/disease.asp?IDNUM=309190


Title: Respiratory Assist Device for ALS
Client: Björn Oskarsson, MD, Assistant Professor of Clinical Neurology, Director of UC Davis Multidisciplinary ALS clinic, University of California Davis Medical Center
Team: Sabrina Levy, Chris Deeble, Sravani Kondapavulur, Sivan Marcus

Purpose:
Amyotrophic Lateral Sclerosis (ALS), also known as “Lou Gehrig’s Disease”, affects around 30,000 Americans. The mean age of onset of ALS is 55, with 50% of patients dying within 3 years, and 75% within 5 years. Patients with ALS experience a gradual motor degeneration, during which they lose mobility throughout their body. The loss of diaphragm innervation necessitates the transition to respiratory assist devices as they lose the ability to breathe independently. Patients with relatively minimal loss of diaphragm control use a bilevel positive airway pressure (BiPAP) device intermittently, which ventilates through a mask over the face. Patient compliance with this device is low, as the BiPAP interferes significantly with their daily life. The next stage in respiratory assist devices is the installation of an invasive ventilator with a tracheostomy. As patients reach respiratory failure in the later stages of ALS, they lose the ability to speak. Due to the low quality-of-life and strong stigma associated with the invasive ventilator, many patients choose to die rather than undergo a tracheostomy. As the patient compliance with ventilation treatments significantly influences lifespan, design of a device that better encourages compliance is critical. This project seeks to develop a noninvasive respiratory assistance device that increases oxygenation while minimizing disturbances to daily life.

 ALS device


Title: Safe Solution to Ascend/Descend Stairs for Elders with Limited Mobility
Client: Janice Schwartz, MD, UCSF Clinical Professor of Medicine, Research Director of the Jewish Home of San Francisco
Team: Hannah Adelsberg, Celia Cheung, Eric Katz, Suzanne Chou

Purpose:
One of the most significant risks to elders living independently is falling. A fall often results in a loss of independence due to injury, such as hip fracture, and also due to a fear of falling again. The majority of fatal falls of elderly individuals happen on stairs, with two-thirds of these occurring on the descent. The number of falls that occur on stairs is extremely disproportional to the amount of time that the elderly spend on them. The most common commercial product to address this need is the stairlift, a motorized chair that ascends and descends a staircase. The stairlift, however, can be prohibitively expensive and is very slow. It also limits the user’s feeling of independence, so some elders do not use it even if it is in their home. There is a need for a lower-cost device that prevents falls on the stairs. This project seeks to develop a device that enables independently living elders with limited mobility to ascend and descend floors in their homes without falling.

 stair device


Title: In vitro System to Test Aerosolized Drug Effects on Pathological Mucus
Client: John Fahy, MD, Msc, Professor of Pulmonary Medicine, UCSF School of Medicine, Director of the CVRI Airway Clinical Research Center
Team: Shalmalee Pandit, Weina Chen, Ryan Zolyomi, Sudershan Srinivasan

Purpose:
Mucus is present in healthy airways to trap and transport foreign particles. Conditions such as asthma, cystic fibrosis, and COPD, however, can result in a buildup of pathological mucus, called sputum, which can obstruct airways. The client’s research goal is to characterize novel aerosolized drugs’ effects on pathological mucus. The current lab setup includes utilizing rheology to determine the elastic modulus of the sputum, which quantitatively measures the effect of the drug on the sputum’s properties. The goal of this project is to develop a safe and effective experimental setup to deliver aerosolized drugs within the existing rheometer setup.

 mucus device


Title: Proper Endotracheal Tube (PET) Detector
Client: John T. Li, MD, Pediatric Critical Care Physician, UCSF Benioff Children’s Hospital
Team: Vivian Shen, Toan Nguyen, Helen Park, Derek Liu

Purpose:
Establishment of an airway is a critical step in emergency care. This involves blindly placing an endotracheal tube (ETT) within a very narrow margin of error. According to, 52.6% of paramedics failed to achieve proper oxygen saturation using ETT’s(2). Bronchial intubation is the most frequent cause of oxygen desaturation (42%), so devices to establish rapid, accurate placement of the ETT are critical. Accurate depth placement, defined along the longitudinal axis as below the clavicles and above the carina, can only be verified using x-ray. The gold standard x-ray is time-consuming, expensive, exposes the patient to radiation, is subject to interpretation, and is not portable for use in the field. Measuring carbon dioxide concentration by capnography or using a CO2 sensitive colorimeter is useful for avoiding insertion into the esophagus, but does not provide the information about depth placement that the x-ray does. Mainstem intubation leads to rapid oxygen desaturation that is undetected by capnography in 88.5% of the cases presented(1). This project seeks to create a portable device that, in a timely manner, communicates accurate placement of an endotracheal tube (ETT) relative to the clavicles and carina, useable in all emergency out-of-hospital settings.

1) McCoy, E. P., W. J. Russell, and R. K. Webb. “Accidental Bronchial Intubation.” Anaesthesia: Journal of the Association of Anaesthetists of Great Britain and Ireland, 22 Dec. 2003. Web. 01 Oct. 2014.

2) Reinhart, D J, and G Simmons. “Comparison of placement of the laryngeal mask airway with endotracheal tube by paramedics and respiratory therapists.” Annals of emergency medicine 1994 : 260-263. Print.

 ETT detector


Title: Detecting Operational Status of LPG Stoves in Developing Countries
Client: Lisa Thompson, FNP, MS, PhD, Assistant Professor at the Clinical and Translational Science Institute KL2, Global Health Sciences Faculty Scholar in Family Health Care Nursing, UCSF
Team: Asad Akbany, Kasper Kuo, Nicholas Leung, Karen Cheng

Purpose:
Respiratory disease is one of the leading causes of death in the world. Traditional cooking stoves are often associated with high exposure to particulate matter (PM) and carbon monoxide (CO). As a result, exposure to cooking smoke causes ~4 million deaths per year in developing countries. Efforts to institute liquid petroleum gas (LPG) stoves in rural areas that traditionally use indoor cooking fires are being made to combat these negative health consequences. LPG stove adoption research is critical to evaluate the efficacy of these programs. Temperature probes are commonly used for monitoring LPG stove usage, but are not accurate enough for optimal data collection. This project seeks to create an unobtrusive LPG stove usage monitor with wireless data collection capabilities.

 stove detector


Title: Hair Sample Preparation for Antiretroviral Testing in Low Resource Settings
Client: Monica Gandhi, MD, MPH, Associate Professor of Medicine in the Division of HIV/AIDS and Infectious Disease at UCSF, Director of AIDS Consult Service at San Francisco General Hospital
Team: Ashley Tsai, Daniel Corbett, Aritro Mukherjee, Anna Ngo

Purpose:
The most important factor in survival with HIV/AIDS is receiving adequate levels of antiretroviral (ARV) drugs. Thus, adherence to ARV therapy is critical to patient outcome. Research has demonstrated that long-term compliance can be monitored by measuring the amount of ARV drug deposited in the matrix of the patient’s hair. ARV extraction from the hair matrix is most commonly performed using methanol as a solvent. Mechanical disruption of the hair matrix is typically employed to maximally expose the hair matrix to the methanol. The common low-budget solution is to manually cut the hair with scissors, which is time and labor intensive. The gold standard method uses a Bead Ruptor to pulverize the hair into a powder, but this device is costly and not feasible in low-income environments. This project seeks to develop a hair processor that efficiently exposes ARV drugs trapped within the hair matrix for solvent extraction at minimal cost.

Hair analysis