Biomedical Engineering Trends in Materials Science Part 19 pptx

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New coatings are under development for controlled and appropriately slow release of
antibiotics or silver from the medical devices. Polymeric hydrogels can be one of the
solutions for the controlled release due to their network structures, which allow a constant
and sufficient release of the antimicrobial agents. Studies have shown that hydrogel
dressings incorporated with antibiotics or nanoparticles assist the wound healing of the
patients and decrease the risk for infections. Another recent development is extracellular
polymeric substance that embeds the modification ofhydroxyapatite, a natural mineral that
exists in the human body. Its pores can be filled with a variety of antimicrobial agents and
provide a slow release mechanism. A new approach of research in inhibition of biofilm
formation is the use of biological substances. Biological surfactants and bacteriophages are
capable to inhibit the growth or destroy the biofilm. However, surfactants are not efficient
against planktonic cells and not able to reduce the risk of infections caused by
microorganisms. In addition bacteriophages can destroy only certain strains. The solution
might be the combined use of different bacteriophages and surfactants to make these
biological substances more universal against a variety of microorganisms. Their efficiency is
confirmed, but since these solutions are newly introduced and developed, there is a big
research potential in this field.
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Biomedical Engineering, Trends in Materials Science
23
The Challenge of the Skin-Electrode Contact in
Textile-enabled Electrical Bioimpedance
Measurements for Personalized Healthcare

Monitoring Applications
Fernando Seoane
1,2
, Juan Carlos Marquez
1,2
, Javier Ferreira
1,3,4
,
Ruben Buendia
1,5
and Kaj Lindecrantz
6

1
School of Engineering, University of Borås,
2
Department of Signal & Systems, Chalmers University of Technology, Gothenburg,
3
Swedish School of Textiles, University of Borås,
4
Department of Telematics Architectures and Engineering at the Polytechnic University of
Madrid,
5
Department of Theory of the Signal and Communication., University of Alcalá, Madrid,
6
School of Technology and Health, Royal Institute of Technology, Huddinge,

1,2,3,6
Sweden
4,5

Spain
1. Introduction
Textile technology has gone through a remarkable development in the field of Smart
Textiles and more specifically in the area of conductive fabrics and yarns. Important
research efforts have been done worldwide and especially in Europe, where the EU-
commission has supported several research projects in the near past e.g. BIOTEX IST-2004-
016789, CONTEXT IST- 2004-027291 and MyHeart IST-2002-507816. As a result of such
worldwide R&D efforts, textile sensors and electrodes are currently available commercially.
Nowadays there are even consumer products with textile sensing technology for heart rate
monitoring integrated in the apparel e.g. Adistar Fusion T-shirt from Adidas or the Numetrex’s
Cardio shirt.
Since one of the main areas of focus where R&D efforts have been concentrated is
Personalized Healthcare Monitoring (PHM) and the fact that most of the efforts developing
textile sensors have been focused on developing electrodes for biopotential signals
recording, it is natural that the main targeted application has been the acquisition of
electrical biopotentials and especially monitoring the ElectroCardioGraphic activity, but also
other types of textile sensors have been investigated e.g. textile stretching sensor (Mattmann et
al., 2008). Nowadays textile-enable stretch sensors are available commercially like the one
manufactured by Merlin Systems. While the application of this type of sensor aims at other
applications than biopotential recordings, an important area of application of stretch sensors
Biomedical Engineering, Trends in Materials Science

542
still is PHM and fitness. This type of sensors can be used for respiration monitoring or
plethysmography applications.
2. Electrical bioimpedance
Electrical Bioimpedance (EBI) is a well spread and established technology that has been
used as a non-invasive monitoring and health assessment technique for more than 50 years.
Since the key-sensing element in EBI measurement technology is an electrode, EBI
technology is a strong candidate to benefit from the current progress in the development of

textile electrodes and conductive yarns.
Currently EBI technology allows non-invasive monitoring of the respiration cycle by
measuring impedance changes across the thorax, cardiac cycle dynamics by measuring
changes in the impedance caused by circulating blood across main arteries as well as
assessment of body composition and body fluid distribution by measuring EBI at several
frequencies. All these current uses of EBI measurements open for several potential textile-
enabled applications within PHM, like Heart Failure management home-bounded patients
aimed by the EU-FP7 MyHeart Project (Habetha, 2006).
Even though EBI technology is a clear beneficiary of textile-based electrode technology and
despite the fact that EBI-enabled wearable physiological measurements is not a new
concept, NASA already in 1969 implemented it during the Apollo XI mission, the potential
provided by textile electrodes is not fully exploited in EBI technology.
In recent years several investigations (Beckmann et al., 2010; Hännikäinen et al., 2007;
Marquez et al., 2009; Medrano et al., 2007) focused on the development of EBI-enabled
physiological variables measurement systems with textile electrodes have produced very
encouraging results suggesting the feasibility to implement EBI textile-enable applications.
The only negative issue with the obtained results is that reliable measurements of EBI have
been obtained only when wetting the textile electrodes.
3. Skin-electrode interface and measurements of EBI
The contact between the skin and the electronic instrumentation in a non-invasive
measurement system is achieved by electrodes. The system resulting from connecting the
measurement leads, the electrodes and the skin creates an electrical interface that might
influence the measurement process. A schematic of the equivalent circuit is depicted in
Figure 1.


Fig. 1. Electrical Equivalent of the Skin-Electrode Interface
The Challenge of the Skin-Electrode Contact in Textile-enabled
Electrical Bioimpedance Measurements for Personalized Healthcare Monitoring Applications

543
The model of the electrical interface contains a voltage source in series with several
impedance elements. The so-called motion artifact in biopotential recordings is represented
by changes in the voltage source. In most cases there are several hardware and software
solutions available to compensate for it (Witte et al., 1987).
An important difference between biopotential and EBI measurements systems is that the
latter, in addition to a voltage measurement, need an injected electrical current through the
skin into the body. The need to inject current into the body requires a good electrical contact
between the measurement system, the electrode and the skin. It is desirable that the
impedance of the electrical interface and the electrode polarization impedance, Zep,
represented in Figure 1 are small enough to be negligible. If a 2-electrode method is used to
measure the EBI, Zep will be added to the measurement and the obtained measurement will
contain not only the EBI but also the interface impedance. When measuring with a 4-
electrode method, it is possible to get an EBI measurement without the contribution of Zep
or the interface impedance.
The existence of the impedance in series with the measurement load and the stray
capacitance creates a frequency dependent current divider, see Figure 2. If the value of the
impedance created by the skin-electrode interface present in the current leads is large, the
electrical current will avoid flowing through the electrode and the skin, leaking away from
the body. Thus the EBI measurement will not be performed at all or in the best case the
obtained measurement data will be corrupted with capacitive leakage. See Figure 3. The
Figure shows an impedance plot, capacitive reactance vs resistance, with the experimental
data plotted with dots, the Cole model estimated from the corrupted data plotted with a fine
line and the Cole model estimated from the artifact-free measurement plotted with a coarse
line.
4. Textile electrode in EBI measurements
Although as in any other electrode, both the contact area and the material of the electrode
are very important factors behind setting the values of the elements constituting the skin-
electrode interface. In regular Ag/AgCl electrodes, the electrolytic gel acts “wetting” the
interface and facilitating the charge transfer between the electrodes to the skin. The lack of

an electrolytic agent in dry textile fabrics increases remarkably the resistance, Rs, depicted in
Figure 1.
The value of Rs decreases by wetting the electrodes with water, conductive gel or body
sweet, the latter is often available during exercise. Another alternative is to manufacture
textile electrodes with a special conductive-textile yarn or the appropriate textile structure
aiming to maximize the contact surface.
In any case, until a good and stable skin-electrode interface has been created, EBI
measurements are unreliable. Spectroscopy applications and time-base analysis
applications, where accuracy is a mandatory requirement for implementation, are absolutely
compromised. The unpredictability of the impedance of the Skin-electrode interface creates
an uncertainty that impedes the deployment of any EBI-based healthcare monitoring at the
moment. Fitness and well-being applications might be more robust to a poor skin-contact
electrode due to the sweating factor, but at the moment no EBI-textile monitoring system
has been made commercially available yet.
Biomedical Engineering, Trends in Materials Science

544


Fig. 2. Electrical equivalent of a EBI measurement setup with a parasitic capacitance in
parallel with the impedance load.



Fig. 3. Typical impedance plot of a measurement showing data deviation caused by a
capacitive leakage.
The Challenge of the Skin-Electrode Contact in Textile-enabled
Electrical Bioimpedance Measurements for Personalized Healthcare Monitoring Applications

545

5. Conclusion
The natural dryness of the textile material used nowadays as electrodes may not be an
impediment for acquiring biopotentials, but it definitely influences in the skin-electrode
contact. A dry interface increases the impedance in series with the current injection leads
impedance thus preventing the electrical current used to perform the EBI measurement
from entering the body. Such impeding electrode-skin interface contributes to generate
measurement artifacts producing unreliable EBI data, which consequently delays any
deployment of textile-enabled EBI applications. The availability of a ‘wet’ textile electrode
that could facilitate the ionic transfer of charges across the Skin-Electrode interface would
definitely facilitate the proliferation of textile-based EBI applications.
Meanwhile such a material is made available the most likely alternative to produce textile
electrodes that create a large contact surface with the skin decreasing the value of the skin-
electrode as much as possible to facilitate the charge transfer from the measurement system
to the measurement load i.e. the body through the skin.
EBI technology can be used to assess on hydration status, monitor the cardiac function,
detect fluid accumulation on the limbs and lungs for early edema monitoring, detect
ischemic tissue for detection of rejection in organ transplantation and also for monitoring
lung function as well as respiration rate.
The successful integration of textile-based sensors in EBI measurements systems would
enable the implementation of e-health application for Personal Healthcare Monitoring that
would truly cause a shift on how clinical practices are delivery nowadays.
6. References
Beckmann, L., Neuhaus, C., Medrano, G., Jungbecker, N., Walter, M., Gries, T., et al. (2010).
Characterization of textile electrodes and conductors using standardized
measurement setups. Physiol Meas, 31(2), 233-247.
Habetha, J. (2006). The MyHeart project fighting cardiovascular diseases by prevention
and early diagnosis. Conf Proc IEEE Eng Med Biol Soc, Suppl,
6746-6749.
Hännikäinen, J., Vuorela, T., & Vanhala, J. (2007). Physiological measurements in smart
clothing: a case study of total body water estimation with bioimpedance.

Transactions of the Institute of Measurement and Control(29), 337-354.
Marquez, J. C., Seoane, F., Valimaki, E., & Lindecrantz, K. (2009). Textile electrodes in
electrical bioimpedance measurements - a comparison with conventional Ag/AgCl
electrodes. Conf Proc IEEE Eng Med Biol Soc, 1, 4816-4819.
Mattmann, C., Clemens, F., & Tröster, G. (2008). Sensor for Measuring Strain in Textile.
Sensors, 8(6), 3719-3732.
Medrano, G., Beckmann, L., Zimmermann, N., Grundmann, T., Gries, T., & Leonhardt, S.
(2007). Bioimpedance Spectroscopy with textile Electrodes for a continuous Monitoring
Application. Paper presented at the 4th International Workshop on Wearable and
Implantable Body Sensor Networks (BSN 2007).
Biomedical Engineering, Trends in Materials Science

546
Witte, H., Glaser, S., & Rother, M. (1987). New spectral detection and elimination test
algorithms of ECG and EOG artefacts in neonatal EEG recordings. Medical and
Biological Engineering and Computing, 25(2), 127-130.


Part 5
Biomedical Engineering Trends:
High Level View

24
Project Alexander the Great:
An Analytical Comprehensive Study on the
Global Spread of Bioengineering/Biomedical
Engineering Education
Ziad O. Abu-Faraj, Ph.D.
American University of Science and Technology
Beirut,

Lebanon
1. Introduction
Bioengineering/Biomedical Engineering is globally considered as one of the most acclaimed
fields in science and technology, and has been a primer for advancements in medicine and
biology. Recently, healthcare practices have been guided towards new emerging frontiers,
including, among others, functional medical imaging, regenerative medicine,
nanobiomedicine, and artificial sensory substitution. On the other hand,
bioengineering/biomedical engineering education has been evolving and proliferating since
the late 1950's, and is undergoing advancement in leading academic institutions worldwide
(Harris et al., 2002). The first program to be officially launched in biomedical engineering
was at Drexel University, Philadelphia, PA, USA, in 1959 at the master's level. This program
was soon followed by Ph.D. programs at Johns Hopkins University, Baltimore, MD, USA,
and the University of Pennsylvania, Philadelphia, PA, USA, (Pilkington et al., 1989). At
present, a surge in the development of new curricula in bioengineering/biomedical
engineering around the world is witnessed, particularly in developing and transitional
countries. These programs are somewhat diverse and vary in their academic content, as well
as within the different tracks constituting the various areas of bioengineering/biomedical
engineering: artificial organs; assistive technology and rehabilitation engineering;
bioelectromagnetism; bioethics; biomaterials; biomechanics; biomedical instrumentation;
biomedical sensors; bionanotechnology; biorobotics; biotechnology; clinical engineering;
medical and bioinformatics; medical and biological analysis; medical imaging; neural
engineering; physiological systems modeling, simulation, and control; prosthetic and
orthotic devices; and tissue engineering and regenerative medicine.
Notwithstanding these advancements in Bioengineering/Biomedical Engineering, there still
exist several shortcomings related to the lack of coordinated interaction among an intricate
body of key-players within this field, involving students, universities, hospitals, industries,
professional societies and organizations, and governmental agencies and ministries. These
shortcomings have brought forth the formation of “the right hand not knowing what the left
hand is doing” syndrome among the constituting entities. Thus, in order to enhance the
Biomedical Engineering, Trends in Materials Science

550
spread of the said field, and strongly contribute to its solidification, these deficiencies await
to be appropriately rectified. There is no doubt that there exists awareness within the
bioengineering/biomedical engineering community of the aforementioned shortcomings;
however, the work done on alleviating these deficiencies has been restricted per se to
organized student internships in industry and consortia of universities on a limited scale,
and national and international conferences held by professional societies and organizations
on a larger scale.
The above mentioned syndrome could be effectively and strategically remedied by taking
advantage of the world-wide-web to establish an interactive cyber-space network involving
all key-players within the field and thus enhancing the communication among these entities.
Consequently, this study, bearing the name ‘Project Alexander the Great’, was designed
with an attempt to effectively augment the remedy of this syndrome.
Project Alexander the Great is an original study on the global spread of
bioengineering/biomedical engineering education (Abu-Faraj, 2008a). This endeavor began
in September 2007 by the Department of Biomedical Engineering at the American
University of Science & Technology (AUST, Beirut, Lebanon). The objectives of this project
are to identify, disseminate, and network, through the world-wide-web, all those
institutions of higher learning that provide bioengineering/biomedical engineering
education, with the potential of incorporating emerging programs. This endeavor will create
the foundation and environment necessary for the above sought interactive communication
among the various stakeholders within the field of Bioengineering/Biomedical Engineering.
The provided information is essential, up-to-date, and could be used by the following
bioengineering/biomedical engineering target audience: students, faculty, research
scientists, and practitioners. In addition to other closely related vocational professions, such
as industry, accreditation agencies, professional societies, academic institutions of higher
education, ministries of higher education, and other governmental agencies.
Before expounding, the reader's attention is drawn to the fact that this chapter refers to
bioengineering and biomedical engineering interchangeably. Katona emphasized that

“there is no consistent distinction between academic departments bearing one or the other
designation and the two terms are often used interchangeably” (Katona, 2002).
2. Background
An early study pertaining to the academic growth of biomedical engineering as a new career
was conducted by Schwartz and Long (1975). This study was based on a 1974 survey
around biomedical engineering education, and was jointly conducted by the American
Society for Engineering Education and the Engineering in Medicine and Biology group of
the IEEE. The objective of this survey was to “identify all the engineering schools in the
U.S. having Biomedical Engineering degrees, options or programs”. This survey
utilized a questionnaire that was administered at 222 engineering schools, and whose major
findings as reported by the authors are presented in Table 1.
Potvin et al. (1981) conducted a quantitative study about biomedical engineering education
comparable with that reported by Schwartz and Long (1975). However, this study utilized
an in-depth survey questionnaire that was modified from the one used in 1974, and was
distributed to 251 engineering schools in the United States.
Project Alexander the Great: An Analytical Comprehensive Study
on the Global Spread of Bioengineering/Biomedical Engineering Education

551
Total U.S. engineering schools surveyed (early months of 1974) 222
Schools having degrees or programs in Biomedical Engineering (BME) 121
Schools with no programs or degrees in BME 76
Schools who did not respond 25
Schools awarding degrees in BME 49
B.S. degree 25
M.S. degree 37
Ph.D. degree 38
Schools offering options or programs in BME in which the student
received some other engineering degree
88

BME student enrollment for the 1973 fall semester 3769
B.S. degree 1530
M.S. degree 1306
Ph.D. degree 933
BME degrees awarded between 1965 and 1973 fall semester 2889
B.S. degree 574
M.S. degree 1424
Ph.D. degree 891
Table 1. Summary of reported results from Schwartz and Long (1975).
The new questionnaire covered enrolment, courses, and degrees data for the academic year
1979-1980, as well as employment data from the academic year 1978-1979. Table 2
summarizes the major findings of this survey. According to this study, the number of
schools offering B.S., M.S., and Ph.D. programs in biomedical engineering increased,
without exception, within the five years that preceded the study.
The study was sponsored by the Education Committees of four societies: i) the Biomedical
Engineering Division of the American Society of Engineering Education; ii) the IEEE
Engineering in Medicine and Biology Society; iii) the Biomedical Engineering Society; and
iv) the Alliance for Engineering in Medicine and Biology.
In 2002, a web-based directory of 102 universities with biomedical engineering programs
within the United States was released by the IEEE Engineering in Medicine and Biology
Society, Piscataway, NJ, USA (Anonymous, 2002). Four years later, the Whitaker
Foundation, Arlington, VA, USA, published an on-line biomedical engineering curriculum
database covering 119 programs (Anonymous, 2006).
Then, Nagel et al. (2007) published a comprehensive document on medical and biological
engineering and science in the higher educational system in Europe. The document began
with an elucidation of the Bologna Declaration, signed on June 19, 1999, and its objectives,
which subsequent to their implementation have led to the Bologna Process; a European
reform process aiming at establishing a European Higher Education Area (EHEA) by 2010.
The authors reported that, in compliance with the European Union (EU) list of priorities, the
Bologna movement provoked the European Medical and Biological Engineering and Science

(MBES) community to establish their ‘Higher Education Area’ by pursuing the following
guidelines that they later adopted as their target objectives: i) “harmonizing the educational
programs”; ii) “specifying minimum qualifications”; and iii) “establishing criteria for an
efficient quality control of education, training, and lifelong learning”.
Biomedical Engineering, Trends in Materials Science

552
Total U.S. engineering schools surveyed (academic year 1979-1980) 251
Schools having degree programs in BME 71
Schools having official minor or option programs in BME 35
Schools with no programs or degrees in BME 107
Schools who did not respond 38
BME Programs accredited by the Accreditation Board for Engineering
Training/Engineers Council for Professional Development
22

Schools awarding degrees in BME 71
B.S. degree 37
M.S. degree 48
Ph.D. degree 41
Schools offering options or minors in BME in which the student
received some other engineering degree
35
B.S. degree 41
M.S. degree 42
Ph.D. degree 34
BME student enrollment for the 1979-1980 academic year 4158
B.S. degree 2859
M.S. degree 830
Ph.D. degree 469

BME degrees awarded during the academic year 1978-1979 820
B.S. degree 464
M.S. degree 249
Ph.D. degree 107
Placement of the BME graduates of the academic year 1978-1979 630
Industry 253
Government 23
Academia 35
Hospitals or clinics 66
Medical school 100
BME graduate schools 96
Other graduate or professional schools 57
Table 2. Summary of reported results from Potvin et al. (1981).
Within the same context, the authors reported that more than 200 institutions of higher
learning in Europe offer academic programs in MBES at the three levels of education:
bachelor, master, and doctoral. Additionally, the authors emphasized the lack of
international coordination with regard to “contents and required outcome qualifications”.
Notwithstanding this fact, they reported that the interactions in biomedical engineering
education between Europe and the United States have been strong despite the differing
educational environments. The authors continued by stating that starting in 1999 a Europe-
wide consortium has been i) “engaged in projects aiming at creating a comprehensive
survey of the status of MBES education and research in Europe”; ii) “charting the MBES
Project Alexander the Great: An Analytical Comprehensive Study
on the Global Spread of Bioengineering/Biomedical Engineering Education

553
community”; iii) “developing recommendations on harmonized MBES education, training,
and certification”; and iv) “establishing criteria for the accreditation of MBES programs in
Europe”.
Subsequently, in 2004, a Europe-wide participation project under the name ‘BIOMEDEA’

was conceived in order to attain the above said objectives as has been described in
Biomedical Engineering Education in Europe – Status Reports (Nagel, 2005). According to
these reports, BIOMEDEA, which is mainly sponsored by the International Federation for
Medical and Biological Engineering, IFMBE, Zagreb, Croatia, has been progressing in a
productive manner and that 80 European academic institutions had participated in the three
meetings that had taken place. Moreover, agreements had been reached on i) the “Criteria
and Guidelines for the Accreditation of Biomedical Engineering Programs in Europe” and
ii) a “European Protocol for the Training of Clinical Engineers.”
3. Materials and methods
The initial phase of Project Alexander the Great was to create a database of the academic
institutions offering bioengineering/biomedical engineering education. Accordingly, a
survey was conducted on all 10453 universities recognized by the International Association
of Universities, UNESCO, Paris, France (Anonymous, 2007a), spread among the 193
member states of the United Nations, New York, NY, USA, within the six continents. Table
3 depicts the classifications comprising the database that was created thereof. A 0.06125%
discrepancy exists in the sum total of the continent population from that of the total
population, reflecting the population of small islands and Western Sahara which was not
accounted for.
A world-wide-web search, using Google's search engine, Google Inc., Mountain View, CA,
USA, was initiated, by continent. Once an institution was identified with a
bioengineering/biomedical engineering program, the department's name, address, Uniform
Resource Locator (URL), year established, and director’s name and coordinates were
gathered. Because of the scale and the perseverance required to gather the desired data, a
methodical search procedure was deemed necessary and accordingly was set and
implemented. This procedure consisted of two iterations explained herein.
The main iteration was to utilize the web. A cut-off limit of 15 minutes was set for the search
of whether or not an academic institution had a bioengineering/biomedical engineering
program, after which the search proceeded to the next institution. This approach was found
mandatory in order to avoid any blockage that may unnecessarily hinder the process.
Instances of such hindrances include, but not limited to, language barriers, weak website

design, and no or poor internet accessibility. Subsequent to this iteration, the success rate
was calculated as the ratio of the number of successes to that of failures. A success was
coined with the ability to connect, confirm (existence or no existence), and acquire
information; while, failure meant the inability to connect or no information.
A complementary iteration, aiming at contacting the pertinent embassies/consulates/
ministries of higher education, was executed at the end of the first iteration in order to assert
the study’s findings. This iteration served to boost the success rate.
Moreover, the possibility of having a bioengineering/biomedical engineering program
erroneously marked as ‘failure’ is not considered problematic, because of the obtained high

Biomedical Engineering, Trends in Materials Science

554
CLUSTERS PROPERTIES
Continent Countries Population
Academic
Institutions
Africa 53 1007430000 793
Asia 44 4244615000 4147
Europe 47 610708000 2204
N. America 23 539611000 2401
Oceania 14 33946000 75
S. America 12 388868000 833
TOTAL 193 6829361000 10453
Table 3. The clusters and properties of the study database. (Population Data Source: World
Population Prospects - The 2008 Revision, Department of Economic and Social Affairs,
United Nations, New York, NY, USA, 2009).


Fig. 1. The front side of an early flyer made to promote Project Alexander the Great.

rate of success, and which could be alleviated by having the concerned academic institution
filling out and submitting an e-form, which is provided on the project's website, whose URL
is www.projectalexanderthegreat.com. Figure 1 shows an early flyer used to promote the
project in regional and international assemblies of bioengineering/biomedical engineering.
4. Results and discussion
Statistical results pertaining to the distribution of bioengineering/biomedical engineering
education in the six continents are presented in Table 4. The success rates were 70.74% for
Africa, 66.19% for Asia, 82.67% for Europe, 94.13% for North America, 94.67% for Oceania,
and 96.76% for South America. The obtained success rates for South America, Oceania,
North America, and Europe strongly support the methodology implemented in Project
Alexander the Great. With regard to those obtained for Africa and Asia, which are
considered satisfactory, there are several possible reasons behind these numbers. The
difficulties encountered in this project include, language barriers – particularly in Asia
because of the vast spectrum of differing languages, e.g., Russian, Farsi, Chinese, Japanese,
Korean, etc.; inexistence of a website; weak/non-interactive website design; no or poor
Project Alexander the Great: An Analytical Comprehensive Study
on the Global Spread of Bioengineering/Biomedical Engineering Education

555
internet accessibility; lack/inadequate published information; contaminated websites,
among others. In any case, encountered failures are expected to diminish with time as long
as the sustainability of Project Alexander the Great is maintained.
Table 4 contains 19 items with data pertaining to the six continents. For ease of navigation,
the data could be compartmentalized into five categories: i) generic data about the world
population, world countries, and recognized world universities; ii) basic demographic,
geographic, and academic data by continent; iii) Project Alexander the Great survey data
pertaining to universities and countries offering bioengineering/biomedical engineering
education by continent; iv) statistical distributions pertaining to demographic, geographic,
and academic data by continent; and v) Project Alexander the Great statistical distributions

pertaining to universities and countries offering bioengineering/biomedical engineering
education by continent.
According to the number of universities offering curricula in bioengineering/biomedical
engineering, as depicted in Figure 2, there is good evidence that education in this field has
globally proliferated. What is worth noting, however, is the fact that the aforementioned
numbers are clustered within each continent as depicted in the percent of countries in
continent offering bioengineering/biomedical engineering: 13.21% for Africa, 52.27% for
Asia, 61.70% for Europe, 26.09% for North America, 14.29% for Oceania, and 50.0% for
South America.
Nevertheless, an appraisal of the evolution and proliferation of bioengineering/biomedical
engineering as a field of study, in a chronological order since its inception (Abu-Faraj,
2008b), as well as the current global explosion of technology that is outreaching what were
once considered as remote areas, indicate that the next few decades will probably witness a
wider diffusion of bioengineering/biomedical engineering education into new countries
within each continent. Furthermore, if the coordinated interaction among the key players
within the field of Bioengineering/Biomedical Engineering, namely students, universities,
hospitals, industries, professional societies and organizations, and governmental agencies
and ministries, is enriched and solidified, then such diffusion is more viable.
The mapping of bioengineering/biomedical engineering education within the six continents
is illustrated in Figures 3-a through 3-f, and is concurrently followed by a basic analysis
pertaining to the academic distribution of the said field within each continent.
However, in order to better understand the illustrated distribution within each continent, a
metric had to be formulated by dividing the number of population in a continent by the
number of bioengineering/biomedical engineering programs offered within the same
continent. Then, the smallest of the six obtained numbers was selected to normalize all
values to a unitary value. The following factors were obtained: 32.31 for Africa, 6.44 for
Asia, 1.68 for Europe, 1.00 for North America, 1.42 for Oceania, and 5.59 for South America.
It should be noted that the smaller the factor the higher is the outreach of
bioengineering/biomedical engineering education per individual per continent.
Accordingly, upon examining Figure 3a for Africa, it is apparent from the extent of the

white shading that this continent lags behind that of North America by a factor of 32.31:1.00.
For example, if equal samples of 1000 individuals from both continents are considered, then
for every 32 individuals receiving bioengineering/biomedical engineering education in
North America, only one individual is offered such an education in Africa, resulting in a
ratio of approximately 1000:31.