PMRRS: Patient Monitoring, Rescue and Response System

2004 Dr. Abhinav Aggarwal, Senior Member IEEE

Project Technical Description: Executive Summary At-risk patients are vulnerable to sudden abnormality in body condition that can prove fatal. They would be unable to activate any gadget or call for help if they lose control over limb movement. Unattended seniors and at-risk patients suffer a greater chance of exposure to such circumstances. PMRRS (Patient Monitoring, Rescue and Response System) is a research initiative of futurecity Inc. in collaboration with University and Hospital partners in a networked organization. The core of PMRRS is a human identification and medical database linked to a biosensor driven radio/satellite based tracking system that can uniquely identify and rescue patients globally and respond to provide help in case of an emergency. The immediate focus is to develop a cost-effective bio-sensing system to monitor critical body conditions and generate alert triggers that can be transmitted to a monitoring station in case of an abnormality. This capability would be packed in a patient-wearable small device. The monitoring station can dispatch ambulance and provide them with vital information about patient medical history. Most existing systems providing similar help require the patient to activate a communication channel and are confined to operate within the home. With PMRRS, no human intervention would be required to monitor body conditions and generate alerts. The automatically received signal shall be immediately processed and rescue teams dispatched, as needed. This system can, in particular, benefit the patients suffering from Alzheimers, infirm seniors and all at-risk cases. During the initial phase, PMRRS global database has been developed. A PMRRS Card bearing a unique identification number and emergency medical data shall be issued to the patient. A low-cost RFID device will be integrated in the first phase for authenticity verification and provide tracking over limited distance, like within a hospital or community facility. Eventually, we plan to develop a global rescue and response system that allows unrestricted mobility and freedom to the at-risk patient. The proposed system will generate a bio-sensing monitored alarm-alert to indicate an abnormal body condition. In a typical application, the signal radiated by the remote chip is picked by suitable radio/satellite channels and transmitted to a base station and vital data retrieved from a medical/bioinformatics database is made available to rescue agencies. Position coordinates of the remote chip are computed, unique identity of its wearer and the abnormal body condition generating the trigger is known. Relevant patient medical records will be accessed by the hospital or emergency room for advance preparation and treatment. Among several interdisciplinary technologies considered for integration during different phases of this three year research project are: database search optimization, RFID, bio-sensing, RF, miniature/micro antenna for highly efficient satellite uplink, embedded systems, metamaterials, ultra-low power clock generator, physical design tools for low-powered logic circuits, brain-wave, computer-brain connection, bio-informatics, forensic and material science. At every phase, cross-functional scientific techniques would be evaluated and the appropriate technologies would be integrated to design and deliver a workable prototype suitable for production. The technology choices will be evaluated for effectiveness using the FIA (Flexibility, Integration, and Automation) framework. A core feature common to all phases of development is the use of patent pending technique that aids in uniquely identifying and helping a patient. Final version of the device shall be capable of monitoring, tracking, rescuing and responding to patients globally, across national and natural boundaries. PMRRS: Patient Monitoring, Rescue and Response System Abstract: PMRRS (Patient Monitoring, Rescue and Response System) research initiative is a bioinformatic human identification and medical database linked to a biosensor driven radio/satellite based tracking system that can uniquely identify and rescue patients globally and respond to provide help in case of an emergency. A cost-effective

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bio-sensing system monitors critical body conditions to generate alert triggers that can be transmitted to a monitoring station in case of a life-threatening abnormality. This capability is packed in a patient-wearable device. The monitoring station can dispatch ambulance and provide vital information about patient medical history. PMRRS would require no human intervention. The automatically received signal shall be immediately processed and rescue teams dispatched, as needed. This system can, in particular, benefit at-risk patients suffering from Alzheimers, infirm or unattended seniors and cases vulnerable to lose control over limb movement. Introduction: The objective of our research project is to develop an integrated system that provides patient identification, monitoring of abnormal body conditions, tracking, rescue and response to deal with life-threatening emergencies. During the initial phase, PMRRS prototype database is under development. A PMRRS Card bearing a unique identification number and emergency medical data will be issued to the patient and RFID device integrated for authenticity verification and provide tracking over limited distance, like within a community facility or hospital premises. Eventually, we plan to develop a global rescue and response system that allows unrestricted mobility and freedom to at-risk patients. The proposed system will generate a bio-sensing monitored alarm-alert to indicate an abnormal body condition. In a typical application, the signal radiated by the remote chip is picked by suitable radio/satellite channels and transmitted to a base station. Position coordinates of the remote chip are computed, unique identity of its wearer and the life-threatening abnormal body condition known, vital patient data and medical records accessed by the ambulance, hospital or emergency room for advance preparation and treatment. Among several interdisciplinary technologies considered for integration during different phases of this three year research project are: database search optimization, RFID, bio-sensing, RF, miniature/micro antenna for highly efficient satellite uplink, embedded systems, metamaterials, ultra-low power clock generator, physical design tools for low-powered logic circuits, brain-wave activity, computer-brain connection, bio-informatics, forensic and material science. At every phase, cross-functional scientific techniques would be evaluated and the appropriate technologies integrated to design and deliver a workable prototype suitable for production. The technology choices will be evaluated for effectiveness using the FIA (Flexibility, Integration, and Automation) framework. Final version of the device shall be capable of monitoring, tracking, rescuing and responding to patients globally, across national and natural boundaries. This functionality would be packed in a patient-wearable device. No human intervention would be required to monitor body conditions and generate alerts. The automatically received signal shall be immediately processed and rescue teams dispatched, as needed. The Need: At-risk patients are vulnerable to sudden abnormality in body condition that can prove fatal. Under such circumstances, they would be unable to activate any gadget or device if they may have lost control over limb movement owing to the abnormal condition. Even if the control of limb movement is not lost, in a condition like Alzheimers, the patient may not be in a position to recall the action needed for handling the emergency. These can be instances when one has suddenly lost the ability to dial 911 for help. Unattended seniors and at-risk patients suffer a greater chance of exposure to such circumstances. There is a need to develop a device that can be suitably worn by the at-risk patient, is linked to biosensors that continually monitor the body conditions, is capable of identifying an abnormal condition and generates a trigger for alarm/alert for immediate dispatch of rescue teams. This device needs to be linked to an online database system that can be accessed by authorized medical service providers and hospitals for advance preparedness. Thus, PMRRS acts as an emergency life saving device linked to a medical/bioinformatics database. Project Overview PMRRS is a medical/bioinformatics database linked to radio based tracking device and bio-sensing mechanism to generate abnormality alert triggers. The UIN (universal identification number) can uniquely identify a patient in the manner that protects privacy and secures the confidentiality of patient information. The PMRRS device will be suitable for wearing or carrying by an individual. The final device version is a chip that can, upon automatic biosensed activation, transmit an electro-magnetic signal that is picked by RFID readers, cellular and satellite networks. This signal is relayed to a centralized location where reverse triangulation technique determines the position

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coordinates of the transmitting point (and the patient wearing the PMRRS device.) Emergency rescue teams/ambulance are immediately alerted and dispatched, as applicable. Authorized hospital or medical service providers are given access to required medical history by access to medical/bioinformatics database for advance preparedness (Refer Figs. 1.1 and 1.2).

UIN PMRRS Database: UIN (Universal Identification Number) is a system and method to uniquely identify a patient. A UIN PMRRS Card bearing this unique number and rescue device will be issued to the applicant, in a wristband like wearable arrangement. The number issued for display on the UIN PMRRS wrist-band and used for accessing data online preserves the privacy of individual by hiding sensitive information. This is achieved by making only the required information available to those who are authorized to view specific data, on a need to know basis. Medical/bioinformatics domain of this database holds all vital bioinformatic data that uniquely identifies the patient and medical records that can be released to authorized and authenticated hospitals, ambulatory care units or medical practitioners for advance preparedness in case of medical emergencies. Patient Rescue and Response System (PMRRS): Once the UIN PMRRS wristband is issued and the relevant bioinformatics/medical data of the UIN holder obtained and stored in a secure environment. During the initial development, we plan to integrate biosensing to recognize the abnormal body condition and write a bit change in RFID device to trigger the alarm/alert for localized application. Patients can be tracked and rescued by monitoring changes in body conditions. UIN PMRRS device can also be equipped with a user-activated SOS alert trigger. Thus, it can become a supplemental support for Amber Alert, as a system used to prevent child abduction, dramatically improving its effectiveness both in terms of response time and as a technology aid to positioning, tracking and rescuing (Refer Fig. 1.2). While the UIN PMRRS Chip is under development, there can be several innovative local applications. For instance, scuba divers can wear a specific device suitable for local communication with a boatbased system (using Sonar or suitable underwater communication technique) and each device can be matched to the UIN. Since UIN is a global identifier, appropriate mechanism can be built to relate UIN with the local device. UIN PMRRS wristbands bearing RFID tags can also be used for tracking at amusement parks. Biosensing the abnormal body conditions: Biosensing relates to systems that include various means, like electronic, photonic, chemical, biologic, mechanical, etc. for producing signals that can identify, monitor and control the biological phenomena. Applications range from health, environment to chemo-bio agents. Biosensor devices often employ biological components that provide selectivity and/or amplification for the detection of biochemical materials [22]. To detect abnormal body conditions like stroke, extremely high and low blood pressure or temperature, insulin levels, sudden accident conditions like flip or fall, strong electromagnetic radiation or suicidal urge, etc., suitable sensors capable of measuring appropriate levels related to these body or brain conditions are required. These sensors can be fixed at required locations on the human body and generate an electromagnetic impulse to indicate an abnormal condition. The UIN PMRRS device chip will trigger an alarm/alert signal for transmission to UIN PMRRS HQ, when activated by this impulse. The HQ PMRRS system will immediately dispatch search and rescue teams, air, land or sea ambulance, alert the nearest hospital and provide them with access to bioinformatics/medical database records of patient for advance preparedness to deal with the emergency. While initial phases of the project would focus on integrating existing COTS biosensing devices to monitor certain abnormal body conditions, advance phases would focus on taking advantage of the current research in medical nanotechnology or nanomedicine, nanorobots and nanochemoagents in diagnostic and biosensing. Also, one of the focus areas for our research would be to fine-tune the specific biosensing mechanism and device sensitivity to filter false alarms from genuine life threatening alerts. Current Status of Patient Tracking/Rescue Technologies & Systems: There are a number of systems available with GPS (Global Positioning System), INMARSAT, Radio Beacons or simple triangulation techniques using either satellite, cellular or other wireless networks to determine and communicate position coordinates to a base location. The base location alerts the search and rescue teams upon receiving the distress signal from the remote unit. Most of these schemes are oriented for aircraft navigation, vehicle fleet tracking or disaster recovery. The ones focused on patient emergency response are confined to operation within vicinity of a house. Most systems dont incorporate biosensors and require human intervention to activate/operate. None of these systems are suitable for patient tracking/rescue owing to the following reasons:

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1. Some of these systems are bulky to be carried at all times, given the size of different equipment required for the application. 2. System requires adequate power to operate, something that is not continually available. 3. There is no system in operation internationally that identifies and tracks patients on a global basis, cutting across boundaries of nations and nature. 4. High transmission EIRP is required for any meaningful signal strength at the receiving end. 5. Large antenna size/gain is required for systems operating through geo-stationary satellites. 6. Most systems are designed primarily for other applications. Systems designed for tracking elderly persons in distress or pets use cellular channels or phone landline mediums that may not be globally available in all regions. e911, a system that enables cellular service providers to determine position coordinates of the cell phone holder requires the cell phone to be carried and be in operation. 7. Very expensive for mass-scale deployment by the governments as a public use system. Also, none of these systems is integrated to a universal human identification and bioinformatics database. Brief System Specification: UIN PMRRS will be a human wearable device and meet the requirement of Patient Rescue. It will need to be capable of communicating the device identification, time stamp, and the abnormality body condition generating the bio-sensed alert, through one or more transmission channels. The complete system has to function in such a manner that position coordinates of the remote device can be determined by reverse triangulation, the identity of wearer and abnormality known by optimized database search. The project research objective is to develop this remote device as a chip and supporting infrastructure within reasonable timeframe and cost. The chip, when mass produced, will be affordable in price, consume bare minimum power to operate and be very small in size, suitable for wearing like a wrist watch, integrated within UIN PMRRS card. There will also be a provision of an emergency push button on the device that activates transmission of a distress signal. Functional Requirements: Approaching the UIN PMRRS chip design problem from different perspectives, the focus is on integrating the following functionalities in the packaged device, suitable for wearing by a patient, and capable of running on extremely low power that can be automatically tapped from body movements: a. An ultra-low power micro sized GPS receiver during initial phases and capability to communicate over wireless Internet and other media channels. b. A transmission circuitry with miniature antenna to radiate a pulse signal suitable for interception by Cellular and Satellite Channels and capability to stamp required data on the pulse signal (like position coordinates, time stamp, bio-sensed abnormal body condition.) Also, an arrangement for triggering patient-driven alarm signal. c. Connection to biosensors that indicate the abnormal condition and trigger an alarm-alert by riding an event code on the transmitted pulse (biosensors can be placed at suitable locations on the body) to monitor the required body or mind conditions. d. Embedded firmware to achieve the required functionality and drive pulse generator circuitry with appropriate event codes for transmission. e. RFID capability to coexist within the enhanced scope of UIN PMRRS chip framework. f. UIN as the identification reference to be correlated with Device ID # (this is achievable at the centralized database end.)

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g. Reverse triangulation system capability (for the last phase, at central location) with pulse signals received from the remote UIN PMRRS device and relayed by intermediate Iridium satellites/cellular towers with position coordinates and timestamps. UIN PMRRS research project would build on translating the above functional requirements to chip design. The project team shall continually keep tracking the advances in relevant cross-functional fields and evaluate the need to integrate newer technologies and upcoming research as an ongoing activity. The technologies scanning cell will be an integral part of the networked project organization and provide a continuum of consulting support through various ongoing phases. A framework based on FIA (Flexibility, Integration and Automation) shall be applied to evaluate alternative technology choice options at various phases of the project. Rescuing Patients in Local Vicinity: We propose that UIN PMRRS cards with RFID tags and integrated biosensors be issued to all patients at hospital check-in, and those living in retirement communities. The RFID readers embedded at strategic points can scan the patients in its range vicinity and generate exception reports for any missing patients, or trigger alerts for patients suffering from abnormal conditions (see Table 1). The area in immediate vicinity of hospital can be monitored by placing RFID readers at suitable points to help track patient movements and rescue them, when required. RFID is a cost-effective solution and suitable even for harsh environments, like extreme temperature exposure (-40 to +150 degrees Celsius.) RFID tags and readers have no moving parts, thus maintenance is rarely required [17]. Since RFID is extremely difficult to copy, it is suitable for confidential identification of patients. The tag and reader communicate in virtually milliseconds, thus RFID is fast. By implementation of a suitable communication protocol in the software, all data related to the patient and the abnormal body condition that triggered the alert can be read in a matter of the fraction of a second. While developing a futuristic RFID tag for incorporation within the overall UIN PMRRS technology suite, we are likely to focus our research efforts in 3 specific directions: 1). Increasing the maximum distance (longer range) between the reader and RFID tag. This can be a multi-pronged research effort that encompasses antenna technology, signal amplification and receiver sensitivity enhancement, among others. 2). Preventing counter-measures: we would research into developing a tamper-proof arrangement that preempts accidental removal of the UIN PMRRS device and generate an alert signal if the device is removed. 3). Incorporating biosensing by multiple condition-identified write capability to switch the parameter within RFID tag to track and rescue patients. Read-write technology is currently being used in applications such as smart cards, prepaid value cards, toll collection and industrial compliance marking.

Developing the Futuristic UIN PMRRS Chip: Constructing a functional UIN PMRRS device that meets performance, power, and size constraints requires an interdisciplinary approach. While a simplistic device with RFID tags can be a workable solution to meet the immediate needs, we propose innovations on some key areas like miniature antenna for highly efficient satellite uplink, ultra-low power clock generator and physical design tools for the low-power logic circuits, metamaterials, bio-sensing, nanomedical technology among others. While achieving some of the functionality of UIN PMRRS system can be made possible by putting together several disparate existing systems and technologies, the real research challenge in the project is to achieve the required functionality by an extremely small and highly efficient system. The UIN PMRRS microchip has to be extremely low on power consumption. Towards that objective, we not only have to use the latest and emerging tools and techniques in ASIC design, but also integrate several functionalities within the development framework. We also have to evaluate various techniques that can be fused into the design to make the device a tamper-proof arrangement to avoid accidental removal by the patient. To take advantage of current and futuristic advances, we shall retain the flexibility to pick between the most suitable and cost-effective options in technology choice. While we integrate some of the disparate COTS systems during initial phase, eventually we built-in various functionalities into the UIN PMRRS device chip. The cost of research and development is estimated on an assessment of the effort involved and would not drastically vary by the picking of specific technology choice options.

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Constructing a functional UIN PMRRS device integrated with biosensing mechanism that meets performance, power, and size constraints requires an integrated and interdisciplinary approach. We propose innovations on some key areas like ultra-low power clock generator, physical design tools for the low-power logic circuits, terahertz meta-materials, low powered GPS receiver, miniature antenna to achieve a highly efficient satellite uplink, biosensing, brain wave technology, medical nanotechnology, among others. At every phase of this research project, several of the interdisciplinary technologies would be integrated to deliver a workable prototype that can be suitable for production. Some of the specific techniques that enable enhanced performance in these areas are: 1. Compression schematics for embedded processors. This is an improvement over ILP (instruction-level parallelism) to reduce memory read stalls by over-lapping read latency with other operations, possibly changing the nature of performance bottlenecks in the system. 2. Software Thread Integration. This is a technique for getting more out of less, a crucial requirement for achieving the performance target with an ultra-low power and ultra-small device. Namely, the perceived computational capacity is increased for an ultra-simple microcontroller by efficiently overlapping tasks during otherwise wasted cycles. This achieves the performance of a more complex microcontroller, but with much less power consumption and a smaller device size. 3. Reliable Device Management with Restricted Power Source. This area provides a framework for tolerating erratic power supplies that define embedded tags, including architecture, run-time management, worst-case energy analysis, and hybrid volatile/non-volatile memory technology. 4. Miniature Antenna Technology. This area provides micro-antenna solutions for enabling ultra-small GPS-enabled devices and achieving a highly efficient satellite uplink. 5. Tools for optimization and miniaturization of embedded systems: a). Rotary clock: It is a revolutionary clock generation and distribution scheme useful for embedded design and it helps reduce both the power consumption and size of the chip. b). Efficient Ultra-deep pipelined ASIC design: Pipelining scheme is suitable for submicron circuit design as this technique can help us to achieve multi-activity capability by packaging a lot of functionality in the compressed form. 6. Terahertz Metamaterial: A "metamaterial" displays strong, tunable magnetic activity at terahertz frequencies, an unprecedented property, which is not found in natural materials due to the lack of a magnetic monopole. It will allow developing materials and devices that operate in the gap between optical frequencies and microwave frequencies. This new area of research may be explored to develop a tamper-proof device to prevent accidental removal from a patient. 7. Bio-sensing/ Computer Vision/Brain Wave Technology /Nanomedicine/ Medical Nanotechnology: Specific levels of several conditions related to human body and brain, indicated by the bio-sensors, can be monitored. Preventive measures can be taken in time to prevent a potentially dangerous, life-threatening situation. A major challenge facing portable electronic devices like the UIN PMRRS is power consumption. For microprocessor-based systems, it can be reduced at a variety of levels, from the circuit level up to the application. Designers can leverage application-level knowledge in embedded systems using software thread integration (STI) to reduce the number of cycles wasted on context-switching and interrupt processing, reducing power consumption [20, 21]. STI is a compiler technique that interleaves functions from multiple program threads into a single efficient implicitly multithreaded function. This function cuts or eliminates context switching overhead, reducing the number of instructions to execute, which in turn reduces the amount of time the processor must be on or allows the designer to run the system clock at a lower frequency. Both alternatives save power. The UIN PMRRS system can benefit from STI for both power reduction and custom peripheral functions like biosensing integration. The communication requirements of the device offer an opportunity to reduce energy consumption and system costs yet increase protocol flexibility by reclaiming the idle time in the communication thread for other useful processing.

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For the critical patient monitoring application, UIN PMRRS device requires a reliable power source that can achieve the required transmission signal level when needed. A key requirement for deployment of UIN PMRRS is that these devices have to operate reliably in the absence of reliable energy sources. Because they have to operate indefinitely, they have to derive power from kinetic energy sources available in the environment. Technology exists for replenishing small batteries using only trace amounts of kinetic energy from the environment, such as motion from an individual wearing or carrying a device. This capability builds upon technology that has been tested in real products, such as in kinetic watches. However, these energy sources are non-constant and unreliable. While energy is not limited over long time scales, its availability over short periods is highly erratic. Erratic energy availability will fundamentally reshape the way embedded hardware and software is designed. The proposed research focuses on explorations in system architecture, run-time management, and hybrid memory technology that together can reliably manage unreliable power sources. Miniature Antenna Technology: For the development of a highly efficient satellite uplink (with LEO Iridium) and achieving the maximum gain in our transmit cycle for micro sized UIN PMRRS Chip, a highly effective antenna within the constraints of the small size is required. Miniaturization of antennas has been applied in the development of miniature wireless sensors, wireless communication devices, UAV (Unmanned Aerial Vehicle) applications and implant devices for short range data telemetry. The objective of this part of the work is to exploit the fundamental limits of antenna miniaturization and to prove that it is possible to achieve usable antennas size of the order of the fraction of a wavelength. Rotary Clock Based ASIC Design: Rotary clock is a revolutionary clock generation and distribution scheme [1-8] that is useful for design and development of a microchip based embedded system like UIN PMRRS. Specifically, it helps reduce both the power consumption and size of the UIN PMRRS chip. The rotary clock scheme is based on the principle of wave propagation in transmission lines. A wave can travel within the ring indefinitely, assuming no energy loss. Therefore, with registers attached, the rotary rings serve as a clock distribution mechanism. Rotary clocking scheme promises enormous benefits. First, rotary clock has high tolerance to process variation. Since various clock rings have the capability to synchronize at the same frequency, the fabrication variations at different area on the same chip are averaged. Delay variation of the conventional clock tree is much larger, as is determined by the individual clock paths. More importantly, the rotary clock can provide any skew value with high accuracy. Based on the wave traveling principle, the skew between clock signals at two locations on a ring can be computed as the distance between them divided by the wave speed. Each clock ring generates a complete 360-phase clock signal. The capability of controlling clock skew at such a fine granularity makes it possible to balance path delays using clock scheduling, resulting in substantial circuit speedup. Pipelining scheme is attractive for the deep submicron circuit design. Depending upon the architecture selected for UIN PMRRS Chip design, this technique can help us to condense multiple functionality in the compressed form for high-yield performance packaging. The chip area increase due to pipelining is insignificant, as registers are the only extra logic elements introduced. More importantly, no complex interconnect design is needed as input and output interfaces of the function unit (FU) are the same as the original. Except for data-forwarding interconnects, the routing due to extra register insertion involves local interconnects only and has a relatively small effect on the routing of other nets in the FU design. There are several innovations that can significantly improve the speed and reduce power of the pipelined circuit. [5]. During the design of the UIN PMRRS device, we will design new flipflops with the consideration of rotary clock. Using the FIA framework, we can evaluate these new designs in terms of power and delay to choose the best flip-flop for our UIN PMRRS chip [9]. Terahertz Magnetism Metamaterialfor biosensing: Since biosensing is one of the major UIN PMRRS requirements, we need to explore newer avenues and opportunities in that direction. Certain body conditions are likely to respond to terahertz frequencies, as generated by Metamaterials. Another major research challenges with UIN PMRRS is to make the device tamper-proof so that any accidental metallic covering may not render it dysfunctional. To meet these requirements, we need to study the behaviour of materials that can be substituted for use on-board the device emitting or receiving electromagnetic RF radiation. For example, a normal RF device can possibly be rendered useless by a tinfoil wrap around. A "metamaterial" displays strong, tunable magnetic activity at terahertz frequencies, an unprecedented property. It will allow developing materials and devices that operate in the gap between optical frequencies and microwave frequencies. It opens the door to new applications in areas such as bio-sensing and security imaging. [15] The field of metamaterials is essentially based on design to create new

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materials with a set of desired physical properties that do not exist in nature. By manipulating the structures, scientists can create materials with properties not found in the parent material. Recent advances in this field made it possible to construct a system that exhibits magnetic properties at higher frequencies. The range of materials to be engineered is unlimited, despite the relatively small number of elements found in nature. There has been a growing interest in the possibility of applications operating at higher frequencies in biological and security imaging, biomolecular fingerprinting, and remote sensing and guidance in zero-visibility weather. Bio-sensing, Computer Vision and Brain-wave Technology: Biosensors can be placed on the patient body and brain to monitor various conditions and trigger a signal when an abnormality is encountered. In a lab environment setup, life-threatening situations can be analyzed. A simulation modeling can project scenarios for life-threat from sample body condition sets, and corrective measures can be taken in time to prevent potentially life threatening situations. Computer vision capability can also be integrated into this system for added effectiveness. Computer vision models can block true body conditions and can activate actual vision, revealing identity of patient involved and the abnormal condition, like an accidental fall or stroke. While so far this technique has been experimented to complement video surveillance, the technology can be integrated with RFID readers in the first phase and with UIN PMRRS device in the subsequent phases. A spin off subject for future research from the Human Neural Networks perspective, brain wave technology hypothesis builds its base on the contemporary advances in human-brain to computer connection and remote brain control. The first human brain to computer connection was established at Rutgers University [16.] Thanks to the pioneering work of Rutgers Biomedical Engineering team, the first computer-to-brain link is now used in surgical treatment of Parkinsons disease. At the Duke University in North Carolina, remote brain control device has been developed and successfully tested by guiding radio signals through electrodes interfaced to mice brain and making it maintain its balance and go straight on a rail track. Researchers at the College of Medical Technology at Hokkaido University and Himeji Institute of Technology in Japan have developed a device capable of picking the human brain waves to remotely activate the lights and switch TV channels, called the MCTOS (Mind Control Tool Operating System.) Recently, at Clinical Neuroscience Research Center at Dartford, Kent, a sensor that can record brainwaves without the need for electrodes to be inserted into the brain or even placed on the scalp has been developed. This new sensor will lead to major advances in the collection and display of electrical information from the brain - and could even be used to control machines in a more effective way than is currently possible. This device to measure electrical activity in the brain without the need for electrodes would potentially be very useful. Patients who have Alzheimer's disease and schizophrenia often have delusions about electrodes in their head, and refuse treatment. A non-invasive method would allow to monitor the effects of drugs on the brain over time, and to tailor treatments more effectively for patients, but can also help us to monitor brain conditions related to sudden behavioral changes. Once appropriate techniques are developed to sense the brain-signals from a distance, we may get in a position to remotely bio-sense abnormal body or brain conditions that can lead to new directions in prediction of suicidal tendencies for at-risk patients. Appropriate signals can be generated and intercepted to rush timely help in such situations. Further research with analyzing brain-activity data may lead us to newer directions in biosensing of brain signals [23]. Bio-sensing for Patient Monitoring and Rescue: Seamless integration between sensing mechanism for various patient conditions and other functionality within UIN PMRRS scope can lead to an integrated device for patient monitoring, rescue and response system. The recent advances in medical nanotechnology have opened up new vistas in the area of biosensing. Nanomedicine is the prevention and treatment of disease in the human body through applying nanotechnology. Nanomachines could be used to monitor the bodys internal chemistry. Fixed nanomachines could be planted in the nervous system to monitor pulse, brain- wave activity, and other functions. A more advanced use of nanotechnology might involve implanted devices to dispense drugs or hormones as needed in people with chronic imbalance or deficiency states, once such imbalances are biosensed. Implantable devices will be able to continuously sense and adjust the body's chemical balance, in the bloodstream or in specific tissues. Implanted sensors will be valuable in acquiring a continuous record of the person's state of health. This will allow more sensitive adjustment of the body's state, and earlier detection of problems. Direction for PMRRS Integrating these recent and upcoming advances can build a base for developing a sensing mechanism that leads to identification of suitable bio-chemical changes reflecting the abnormal body condition and electro-magnetic waves

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reflecting brain conditions. Once a suitable measurement system is established and relevant brain-wave parameters and body conditions identified, appropriate bio-sensing mechanisms may be developed to trigger alarm/alert condition by direct or remote signal detection. We plan monitoring patients with bio-sensed UIN PMRRS implementation during third phase of the project, depending on the level of research evolution in peer technologies and emergence of the techniques for integration thereof. Cutting across various approaches, as we research on the project, we shall keep evaluating the technologies as they evolve over the period for suitability as candidate cases and focus on an approach for development that is most cost effective and simple for practical implementation. Social dynamics will be modeled and simulations carried on the FIA framework to study the impact of patient attitude towards acceptance of UIN PMRRS. This analysis would help us to fine-tune certain parameters in UIN PMRRS future designs, as related to patient acceptance or comfort. Evaluations would be made, specific to the candidate technology areas, after considerations on FIA framework and simulation studies. These results can impact the on-going research in developing embedded systems and result in higher effectiveness and cheaper cost by aiding the selection of right technology for the right cause. Social Implications of UIN PMRRS While it is reasonable to expect some resistance from patients to the introduction of a technology based solution that can identify, track and rescue them, it is also logical to analyze that if benefits of the system are presented in a clear manner that reveals its positive aspect of patient safety and help in emergency [see fig. A.1.2,] the patient resistance to UIN can be overcome. Some patients are likely to be concerned about the privacy issues when considering a decision for participation in a UIN PMRRS program, even on a voluntary basis [see fig. A.1.1,] UIN PMRRS addresses these problem issues in a direct manner. The UIN PMRRS architecture is designed on the foundations of securing privacy, protecting identity and building trust. UIN PMRRS can potentially become one of the early technology steps to gain patient confidence, once they are assured of the privacy of data and life saving potential of the system. The UIN PMRRS project implementation would be an interesting case to study the change in patient attitudes and behavior if fence-sitters change minds to join the UIN PMRRS movement. The modeling using system dynamics and FIA framework, supported by simulation, can analyze this change [9-14.] It needs to be analyzed if the benefits offered by UIN PMRRS system can change the patient attitude with regard to privacy concerns in due course of time. One of the easiest ways to overcome the natural resistance to UIN PMRRS endeavor is by making it open on a voluntary basis. If those who opt for it get a convincing assurance that this system protects their privacy and insures their identity, while it also protects their life, acceptance to the system can best spread by word of mouth. Identifying this voluntary plan with an effort to secure and rescue patients will lower the objections. It is by way of appropriate public and patient education that awareness can percolate down the social system. If Hospitals offer a patient the UIN PMRRS option upon check in at no cost, explaining the benefits, it is likely that most patients may opt for it. In reality, it is only after putting such a system to actual use that we can know of its acceptance. By integrating inter-disciplinary high-tech to create a chip that would help in saving lives in times of emergency, assure patients identity and privacy, UIN PMRRS is likely to bring in value to the society. It is only after covering some sample populations during the test phase, analyzing their reactions and experience, and modeling it to project behavioral patterns that we may be in a position to know of its acceptance by society. Since such modeling is planned at early stages of the research, we shall be in a position to fine-tune certain parameters related to patient comfort and acceptance, as related to device design and development. To summarize, this project will: 1. During the initial phase, develop an RFID and biosensing based cost-effective UIN PMRRS system suitable for monitoring, tracking, rescuing patients and providing the required help, as needed. 2. Use system dynamics modeling to study the patient attitude to use of UIN PMRRS technology. 3. Use FIA framework evaluation of social dynamics, evolving technologies and picking the most suitable alternatives for UIN PMRRS development as we progress with this research.

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4. Develop design strategies for integrating state of the art interdisciplinary technologies. 5. Evaluate ultra-low power clock generator and physical design tools for the logic circuits, miniature antenna design, software thread integration and energy efficient power supply during initial development stage of the project. Subsequently, we plan to add bio-sensing capability. 6. Develop a microchip (UIN PMRRS) that helps in uniquely identifying and rescue patients across the globe within a reasonable time frame and cost.

Conclusion UIN PMRRS research initiative would help create an infrastructure to secure the patients, monitor their abnormal body or brain conditions, generate biosensesd alerts automatically without human intervention, dispatch rescue teams and assist to provide pro-active response and treatment to save lives in emergencies. References: [1] X. Liu, M. C. Papaefthymiou, Design of a high-throughput low-power IS95 Viterbi decoder, IEEE Transactions on VLSI, November 2003. [2] X. Liu, M.C. Papaefthymiou, and E.G. Friedman, Retiming and clock scheduling for digital circuit optimization, IEEE Transactions on Computer-Aided Design of Integrated Circuits and Systems, Vol. 21, No. 2, February 2002. [3] X. Liu, M.C. Papaefthymiou, and E.G. Friedman, Maximizing performance by retiming and clock skew scheduling, Proceedings of the 36th ACM/IEEE Design Automation Conference, June 1999. [4] X. Liu, M.C. Papaefthymiou, and E.G. Friedman, Minimizing sensitivity to delay variations in highperformance synchronous circuits, Proceedings of the 1999 IEEE Conference on Design, Automation, and Test in Europe, March 1999. [5] C. Kim and S.-M. Kang, A low-swing clock double-edge triggered flip-flop, IEEE Journal of Solid-State Circuits, vol. 37, no. 5, pp. 648 652, May 2002. [6] H. Partovi, Flow-through latch and edge-triggered flip-flop hybrid elements, IEEE International Solid-State Circuits Conference, San Francisco, CA, Feb. 1996. [7] V. Stojanovic and V. G. Oklobdzija, Comparative analysis of master-slave latches and flip-flop for highperformance and low-power systems, Journal of Solid-State Circuits, Vol. 34, No. 4, April 1999. [8] J. Wood, T. C. Edward, and S. Lipa, Rotary traveling-wave oscillator arrays: A new clock technology, IEEE Journal of Solid-State Circuits, Vol. 36, No. 11, November 2001. [9] Wadhwa S, Aggarwal A, Synergism Of Flexibility, Integration and Automation in CIM Systems, Studies in Informatics and Control, pp13- 27, Vol 9, March 2000. Available on the web at: http://www.ici.ro/ici/revista/sic2000_1/art02.html [10] Aggarwal A, Wadhwa S, Modeling Computer Integrated manufacturing Systems using System Dynamics, proceedings of 5th National Conference on System Dynamics, IIT Delhi, March 1993, Wiley Eastern, pp 240-248. [11] Aggarwal A, Technology for Vehicle Location based on terrestrial network, proceedings of TELDA Seminar, CMC R&D Centre, Hyderabad, 1992. [12] Aggarwal A, Vision of Technology, plenary talk presented at IEEE International Conference SouthesatCon 03, Jamaica, April 2003. [13] Aggarwal A, Sharma P, Enterprise Integration System- A new paradigm for Information management, proceedings of IEEE International Conference on Engineering Management, IEMC 93, New Delhi, India, (IEEE Catalog No: 93H3382-9) Dec 1993, pp 95-101. [14] Aggarwal A September 11: A Wale Up Call Scientific Analysis of the Problem and Suggested Solutions 1stBooks Library, Bloomington, IN, Jan 2003, ISBN # 1-4033-6204-1. [15] T.J. Yen, W.J. Padilla, N. Fang, D.N. Basov, D. Vier, D.R. Smith, J.B. Pendry, and X. Zhang, "THz Magnetic Responses from artificial materials," Science 303, 14941496, 2004. Web version at: http://microlab.seas.ucla.edu/research_new/Researchpics/home.htm [16] Michael J. Anderson, Evangelia Micheli-Tzanakou: Auditory stimulus optimization with feedback from fuzzy clustering of neuronal responses. IEEE Transactions on Information Technology in Biomedicine 6(2): 159-170

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(2002) pp 159-170 [17] Murray, Charles: Airline clears RFID luggage tags for takeoff. EE Times, July 05, 2004, pp 1, 65. Online version available at: http://www.eet.com/showArticle.jhtml?articleID=22104613 [18] S. Y. Larin and T. M. Conte, "Compiler-driven cached code compression schemes for embedded ILP processors,", pdf, presentation; in Proceedings of the 32nd Annual International Symposium on Microarchitecture, (Haifa, Isreal), Nov. 1999. [19] Christopher J. Hughes, Vijay S. Pai, Parthasarathy Ranganathan, Sarita V. Adve, RSIM: Simulating SharedMemory Multiprocessors with ILP Processors, IEEE Computer, Feb 2002, pp 40-49. [20] Vasanth Asokan and Alexander G. Dean. Providing Time- and Space-Efficient Procedure Calls for Asynchronous Software Thread Integration, International Symposium on Compilers, Architecture and Synthesis for Embedded Systems, (CASES 2004), Washington, DC, September 23-25, 2004 [21] Nagendra J. Kumar, Siddhartha Shivshankar and Alexander G. Dean. Asynchronous Software Thread Integration for Efficient Software Implementations of Embedded Communication Protocol Controllers, Conference on Languages, Compilers, and Tools for Embedded Systems (LCTES'04), Washington, DC, June 04. [22] Schultz Jerome S, WTEC Biosensing Workshop, May 13, 2003. [23] Buyya R, et al. Neuroscience Instrumentation and Distributed Analysis of Brain Activity Data: A Case for eScience on Global Grids, available online at: http://buyya.com/papers/neurogrid-ccpe.pdf Table 1: Stages of PMRRS from RFID to integrated device development

Fig. A.1.1: Social Dynamics and Technology: Causal Loops

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Fig. A.1.2: UIN PMRRS Role in Life Saving Operation: Causal Loops

Fig: 1.1: Specific UIN PMRRS Components

Fig 1.2: UIN PMRRS System Operation

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Fig. 1.3: UIN/PMRRS IT Architecture for inter-system operation

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Sequence of Events: 1. Patient in distress presses alarm button on UIN PMRRS device (or bio-sensors trigger an abnormal condition) to activate a signal transmission from UIN PMRRS device. 2. Distress Signal/Alarm Alert trigger is intercepted by RFID reader or Satellite/Cellular Channels and relayed to UIN PMRRS HQ. 3. UIN PMRRS HQ operator dispatches search and rescue teams: land, air or sea ambulance; alerts nearest hospital, as appropriate to the case situation. Simultaneously, authorized hospital or emergency medical aid provider is given immediate access to vital life-saving data from bioinformatics database for advance readiness. 4. Patient is rescued, comforted, transported, gets help or medical care, as applicable. Fig. 1.4 Keeping Patients Safe In Hospital

Figure1.5: Process Flow Chart for Keeping Patients Safe In Hospital Intervention with RFID tag and reader arrangement- PMRRS Stage 1

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Future PMRRS Development Future RFID based PMRRS: While developing a futuristic RFID tag for incorporation within the overall UIN PMRRS technology suite, we are focusing our research efforts in 3 specific directions: 1). Increasing the distance (longer range) between the reader and RFID tag. This can be a multi-pronged research effort that encompasses antenna technology, signal amplification and receiver sensitivity enhancement, among others. 2). Preventing counter-measures: we would research into developing a tamper-proof arrangement that preempts accidental removal of the UIN PMRRS device and generate an alert signal if the device is removed. 3). Incorporating bio-sensing by multiple condition-identified write capability to switch the parameter within RFID tag to track and rescue patients. Read-write technology is currently being used in applications such as smart cards, prepaid value cards, toll collection and industrial compliance marking.

Future PMRRS Chip: Developing the futuristic UIN PMRRS chip that meets performance, power, and size constraints requires an interdisciplinary approach. While a simplistic device with RFID tags can be a workable solution to meet the immediate needs, we propose innovations on some key areas like miniature antenna for highly efficient satellite uplink, ultra-low power clock generator and physical design tools for the low-power logic circuits, metamaterials,

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bio-sensing, nanomedical technology among others. While achieving some of the functionality of UIN PMRRS system can be made possible by putting together several disparate existing systems and technologies, the real research challenge in the project is to achieve the required functionality by an extremely small and highly efficient system. The UIN PMRRS microchip has to be extremely low on power consumption. Towards that objective, we not only have to use the latest and emerging tools and techniques in ASIC design, but also integrate several functionalities within the development framework. We also have to evaluate various techniques that can be fused into the design to make the device a tamper-proof arrangement to avoid accidental removal by the patient. At every phase of this research project, several of the interdisciplinary technologies would be integrated to deliver a workable prototype suitable for production.

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