End-user Involvement Research Articles

What the textbooks don’t teach about the reality of running a digitally enabled health study: a phenomenological interview study

BackgroundMost studies do not produce their intended outcomes on time or within budget. However, it is challenging to identify the facilitators and barriers to successful study management when the “behind the scenes action” of especially digitally enabled health research studies are akin to a black box. Therefore, it is necessary to explore first-hand experience of the facilitators and barriers to managing digitally enabled health studies. The goal of such studies is to produce new knowledge and/or develop tools that can be translated to real-world benefits for the health and care sector, individuals, and other stakeholders. These studies now exist in a time that encourages collaborative research activities with interdisciplinary research partnerships, industry collaboration, end-user involvement and insights for policy. These expectations require teams with different work cultures, methodologies, technologies, and approaches to work together, resulting in significant benefits but also challenges.ObjectivesTo explore the relationship between the dynamics and needs of research teams and the technology used to manage digitally enabled studies through the experience of those who worked on such studies.MethodsWe used an interpretive phenomenological approach to explore research team members’ experiences and perceptions of study management in the field of digitally enabled health research. We interviewed 15 research team members from eight studies. A semi-structured interview guide was used to explore concepts related to study activity management, team dynamics, resources and technologies used to manage research activities, and reflections of personal experiences. An adductive thematic analysis was performed on the transcripts.ResultsFive main themes were identified: 1) Project Team, 2) Study management, which included management technologies, 3) Study plan, 4) Intervention, 5) Participants. This paper focuses on the first two main themes. Sub-themes included: Roles and responsibilities, Methods, Changes, Challenges and solutions and Expectations vs. reality. Sub-themes were applicable to all main themes. Therefore, results were presented as knowledge gained from the interaction between sub-themes within each theme, i.e. referred to as “comprehensive insights” in the results section of this paper.ConclusionThis interview study provides new knowledge about the realities of working in collaborative, digitally enabled health research studies and demonstrates several opportunities for improved understanding of study management. More realistic and thorough understanding of the complex system in which digitally enabled health research exists can be applied to better prepare experienced researchers and newly graduated students entering the field, as well as improve existing strategies for management.

Cocreative Development of Robotic Interaction Systems for Health Care: Scoping Review.

Robotic technologies present challenges to health care professionals and are therefore rarely used. Barriers such as lack of controllability and adaptability and complex control functions affect the human-robot relationship. In addition to educational opportunities, the possibility of individual adaptation can improve the usability and practical implementation of robotics. Previous work has focused on developments from a technology-centered perspective and has included user interests too late in the process. This study addresses the following research question: What cocreative research approaches are used in the field of nursing robotics to improve the usability, intended use, and goal-directed application of robotic developments for nurses and to support the nursing process? This scoping review provides an overview of the topic and the research activities taking place within it. Five databases and the reference lists of the identified publications were searched for studies without further restrictions. Studies were included if they developed and evaluated interaction and control platforms for robotic systems in health care in a cocreative way with end users. The search resulted in 419 hits, of which 3 publications were included. All publications were feasibility or user studies that were mainly carried out in the European Union. The 3 interaction and control platforms presented were all prototypes and not commercially available. In addition to those in need of care, all studies also included family carers and health care professionals. Robotic interaction and control platforms in health care are rarely, if ever, developed and evaluated with feasibility or user studies that include prototypes and end users. While the involvement of end users is crucial, this review emphasizes that all stakeholders, including health care professionals, should participate in the development process to ensure a holistic understanding of application needs and a focus on user experiences and practical health care needs. It is emphasized that the active involvement of end users in the development process is critical to effectively meeting the needs of the target group.

Involving Experts by Experience in Craniofacial Research.

Many areas of health research increasingly involve end users of research (typically patients and their families/caregivers) in study design, management, and dissemination. Beyond recruiting patients as research participants, the shift is towards engaging patients, parents and caregivers as active partners on the research team, who are recognised and valued as 'experts-by-experience' (EbyE). Currently, involving EbyE is not routine in global craniofacial research. This paper highlights the value of EbyE involvement, addresses how to incorporate EbyE at all stages of research and discusses key considerations in facilitating positive experiences for EbyE.

Establishing Quality Indicators and Implementation Priorities for Post-Stroke Aphasia Services Through End-User Involvement.

Currently, there are no agreed quality standards for post-stroke aphasia services. Therefore, it is unknown if care reflects best practices or meets the expectations of people living with aphasia. We aimed to (1) shortlist, (2) operationaliseand (3) prioritise best practice recommendations for post-stroke aphasia care. Three phases of research were conducted. In Phase 1, recommendations with strong evidence and/or known to be important to people with lived experience of aphasia were identified. People with lived experience and health professionals rated the importance of each recommendation througha two-round e-Delphi exercise. Recommendations were then ranked for importance and feasibility and analysed using a graph theory-based voting system. In Phase 2,shortlisted recommendations from Phase 1 were converted into quality indicators for appraisal and voting in consensus meetings. In Phase 3,priorities for implementation were established by people with lived experience and health professionals following discussion and anonymous voting. In Phase 1, 23 best practice recommendations were identified and rated by people with lived experience (n = 26) and health professionals (n = 81). Ten recommendations were shortlisted. In Phase 2,people with lived experience (n = 4) and health professionals (n = 17) reached a consensus on 11 quality indicators, relating toassessment (n = 2), information provision (n = 3),communication partner training (n = 3),goal setting (n = 1),person and family-centred care (n = 1)and provision of treatment (n = 1). In Phase 3,people with lived experience (n = 5) and health professionals (n = 7) identified three implementation priorities: assessment of aphasia,provision of aphasia-friendly informationand provision of therapy. Our 11 quality indicators and 3 implementation priorities are the first step to enabling systematic, efficientand person-centred measurement and quality improvement in post-stroke aphasia services. Quality indicators will be embedded in routine data collection systems, and strategies will be developed to address implementation priorities. Protocol development was informed by our previous research, which exploredthe perspectives of 23 people living with aphasia about best practice aphasia services. Individuals with lived experience of aphasia participated as expert panel members in our three consensus meetings. Wereceived support from consumer advisory networks associated with the Centre for Research Excellence in Aphasia Rehabilitation and Recovery and the Queensland Aphasia Research Centre.

The ERMES chatbot: A conversational communication tool for improved emergency management and disaster risk reduction

The increased occurrence and severity of worldwide disasters, exacerbated by the impact of climate change, pose significant challenges to emergency management, calling for novel and more effective Disaster Risk Reduction (DRR) approaches. Despite the phenomenological differences of diverse hazards and the heterogeneity of local policies and governance structures, effective communication systems are needed to better manage the available resources in all phases of the emergency management cycle, especially in the case of cross-border events. In this work, we present the design, implementation, and validation of a novel tool for emergency management, i.e., the ERMES Chatbot: a mobile-based conversational communication system developed to facilitate real-time bidirectional communication between control centres, in-field forces, and citizens. The methodology used to create the ERMES Chatbot is grounded on the user-centred design approach, which entails end-user involvement in all key phases of the development, including the definition of the end-user requirements, the technical design, and the final validation of the proposed solution. The co-design approach involved several organisations belonging to the DRR domain, which includes a gamified experience for citizens and is iteratively validated through four in-field demonstration events based on realistic emergency scenarios with the involvement of emergency practitioners, volunteering organisations, and citizens.

The roadblocks to success – Identifying challenges in implementing a surgery support E-health solution: A qualitative interview study

BackgroundSurgery accounts for 30 % of the global disease burden, but healthcare systems struggle with managing surgical waitlists, optimising operations, and minimising cancellations, leading to poor patient outcomes and financial strain. E-health technologies offer promising solutions to enhance perioperative care and improve surgical outcomes, yet their integration faces significant organisational and structural challenges. This paper aims to explore and analyse the perspectives of decision-making personnel regarding the challenges and opportunities of implementing a surgery support e-health application. MethodsThis study utilised an explorative qualitative approach, employing a rapid cycle qualitative evaluation informed by the NASSS framework. Data were collected through individual semi-structured interviews with decision-making personnel conducted. Framework analysis guided by the NASSS framework was used to analyse the interview transcripts. ResultsA total of 15 participants from public health and external organisations participated in the study. The analysis, framed by the seven domains of the NASSS framework, critical challenges in integrating new health technologies, emphasising the need for compatibility, cybersecurity, and demonstrating clear benefits. Key factors for successful adoption included early and continuous stakeholder engagement, organisational readiness, and ongoing support. Additionally, participants highlighted the importance of centralised information systems and continuous adaptation of health IT solutions to meet evolving needs. ConclusionThis paper reveals that implementing surgical e-health interventions is a complex process fraught with organisational, technical, financial, and political challenges, particularly due to insufficient end-user involvement and the intricate healthcare landscape. Despite the recognised benefits, successful implementation necessitates comprehensive stakeholder engagement and co-design approaches. Additionally, while a partnership between commercial vendors and public health developers presents an attractive solution, significant obstacles such as intellectual property disputes and resource allocation must be overcome.

Editors' Introduction

This issue of the Interdisciplinary Journal of Signage and Wayfinding underscores the significance of involving end users, including the public, in the design and policy development of signage systems. The issue explores the multifaceted roles of signs and symbols in reflecting community character, supporting business branding, aiding wayfinding, and enhancing placemaking. Emphasizing evidence-based design and research, the articles present diverse methodologies, including stakeholder theory, qualitative studies, and shadowing techniques, to inform signage practices.

Pengujian Alpha dan Beta Testing Pada Aplikasi TIJE

This research discusses the software testing process on the TIJE application using the alpha (blackbox) and beta test methods. Alpha testing is carried out to identify and fix internal errors by the development team, while beta testing involves end users to ensure the application meets user needs and expectations. Test results show that various critical bugs were successfully identified and fixed, improving the quality and stability of the application before being released to the public. The conclusion of this research shows the importance of alpha and beta testing in the software development cycle.

What's different about digital? A qualitative interview study exploring experiences of adapting in-person behaviour change interventions for digital delivery.

Digital health behaviour change interventions may be adapted from in-person interventions, without appropriate consideration of how the digital context might differ. Drawing on the wider literature on behaviour change intervention development, this research aims to explore the digital adaptation process of health behaviour change interventions and the specific considerations for digital modes of delivery. A qualitative interview study. Interviews with 15 intervention developers/facilitators were analysed using inductive thematic analysis. Findings highlight a continuum of digitalization, where variation in technology available and human support influences considerations for digital adaptation. 'What vs how: "trying to do the impossible"' describes the balance between retaining the intervention's active ingredients while modifying for digital delivery. Through 'Trial and error', participants described an iterative process based on experience of delivery. 'Creating connection and engagement' emphasizes the importance of social support and the challenges of replicating this. Several considerations for digital adaptations are proposed including the involvement of end-users (facilitators and recipients) during adaptation, the need to understand the original intervention and new context for use, and the different motivational needs of digital intervention recipients.

Facilitating co-design among older adults in a digital setting: methodological challenges and opportunities

ABSTRACT Healthy ageing is a global priority due to a growing older population, which increases the need for preventive measures and tailored technology. In health technology development, co-design is emphasised as a valuable strategy to support a person-centred approach. Co-design, a value-driven and collaborative approach, involves end users in development processes to overcome barriers connected to capability, opportunity, and motivation. While a growing number of older adults are involved in design processes, there is a deficit of suitable methodologies for achieving active involvement. Additionally, the COVID-19 pandemic necessitated a shift to developing methodological skills and tools to facilitate co-design remotely in a digital setting. Here, we draw on experiences of conducting iterative co-design workshops with a Canadian and a Swedish cohort of older adults about technology development to support mobility, balance, and confidence in daily movement. We describe and discuss methodological and ethical challenges and opportunities to provide recommendations for conducting co-design research in a digital setting with older adults (+65 years). Our recommendations include the use of live mind mapping to facilitate participation involvement, and we address the issue of ‘homework’ in co-design and the importance of setting expectations.

Implementing injury prevention training in youth handball (I-PROTECT) in Sweden: study protocol for a cluster randomised trial

IntroductionEfficacy trials show that evidence-based injury prevention training reduces injuries in youth athletes but effectiveness, that is, outside the controlled setting, is lower and, consequently this training has had limited...

Capacity-building during public health emergencies: perceived usefulness and cost savings of an online training on SARS-CoV-2 real-time polymerase chain reaction (qPCR) diagnostics in low- and middle-income settings during the COVID-19 pandemic.

Upon the onset of the COVID-19 pandemic, the Public Health Laboratory Support Unit (ZIG4) at the Robert Koch Institute (RKI), the German National Public Health Institute, developed and delivered an online training on SARS-CoV-2 qPCR diagnostics to 17 partner countries in low- and middle-income countries (LMIC). This article analyses the usefulness and cost savings of this training. The authors performed a concurrent mixed-methodology study based on key informant interviews, interviewer-administered questionnaires, and document reviews. Economic costs were estimated from the perspective of RKI. Responding participants indicated that the course provided good and comprehensive information on up-to-date scientific knowledge and laboratory practice in PCR diagnostics. Respondents appreciated how the technical content of the training enhanced their ability to apply diagnostic methods in their daily work. Interviewees highlighted that the fast implementation and the low threshold of attending an online training had allowed them to quickly build skills that were crucial during, and beyond, the COVID-19 crisis. The total estimated cost of the online SARS-CoV-2 qPCR training was 61,644 euros. The total estimated cost of the equivalent face-to-face training was estimated at 267,592 euros. Programme weaknesses identified included the top-down approaches taken, lack of interactive components and opportunities to directly engage with other course participants and with teachers. An online training was developed and implemented to support RKI partner countries in SARS-CoV-2 qPCR diagnostics during the COVID-19 pandemic, thereby strengthening pandemic response and health system resilience. The training incurred in important cost savings compared to the equivalent face-to-face training. Post-pandemic studies could usefully build on these research findings and explore ways to enhance end user involvement and improve interactive features to build stronger communities of learners and facilitate exchange of information and mutual learning.

Methods, Indicators, and End-User Involvement in the Evaluation of Digital Health Interventions for the Public: Scoping Review.

Digital health interventions (DHIs) have the potential to enable public end users, such as citizens and patients, to manage and improve their health. Although the number of available DHIs is increasing, examples of successfully established DHIs in public health systems are limited. To counteract the nonuse of DHIs, they should be comprehensively evaluated while integrating end users. Unfortunately, there is a wide variability and heterogeneity according to the approaches of evaluation, which creates a methodological challenge. This scoping review aims to provide an overview of the current established processes for evaluating DHIs, including methods, indicators, and end-user involvement. The review is not limited to a specific medical field or type of DHI but offers a holistic overview. This scoping review was conducted following the JBI methodology for scoping reviews based on the framework by Arksey & O'Malley and complies with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Three scientific databases (PubMed, Scopus, and Science Direct) were searched in April 2023. English and German studies between 2008 and 2023 were considered when evaluating DHIs that explicitly address public end users. The process of study selection was carried out by several researchers to avoid reviewer bias. The search strategy identified 9618 publications, of which 160 were included. Among these included articles, 200 evaluations were derived and analyzed. The results showed that there is neither a consensus on the methods to evaluate DHIs nor a commonly agreed definition or usage of the evaluated indicators, which results in a broad variety of evaluation practices. This aligns with observations of the existing literature. It was found that there is a lack of references to existing frameworks for the evaluation of DHIs. The majority of the included studies referred to user-centered approaches and involved end users in the evaluation process. As assistance for people developing and evaluating DHIs and as a basis for thinking about appropriate ways to evaluate DHIs, a results matrix was created where the findings were combined per DHI cluster. Additionally, general recommendations for the evaluators of DHIs were formulated. The findings of this scoping review offer a holistic overview of the variety and heterogeneity according to the approaches of evaluation of DHIs for public end users. Evaluators of these DHIs should be encouraged to reference established frameworks or measurements for justification. This would ease the transferability of the results among similar evaluation studies within the digital health sector, thereby enhancing the coherence and comparability of research in this area.

The Living Lab to promote educating community development in an inclusive perspective, between innovation and participation

In recent decades, changes in productive and social dynamics have profoundly influenced socio-economic environments, which are now characterized by phenomena such as globalization, the omnipresence of technology and the loosening of social networks. These changes have led to a growing alienation of the individual from the public sphere. In this context, education must focus on fostering in both students and the community a sense of responsibility and belonging, which are essential elements for active participation in political life and building inclusive communities. In light of these premises, the paper illustrates the first steps of a research aimed at the design and implementation of an innovative system for the training of education professionals through a Living Lab, intended as an action-research approach operating between community and innovation. This approach, based on action-research, involves communities and innovation to develop a digital platform that fosters the sharing of inclusive practices. The goal is aligned with international policies and recent scientific debate, which emphasize the need for sustainable growth models that reduce inequalities and combat social exclusion. The Living Lab is configured as a methodology that enhances the involvement of end users in the design and co-creation of innovative training services. This approach not only collects data on the process itself, but implements interventions with short, medium and long-term impacts. In summary, the Living Lab represents an opportunity to develop innovative educational practices, integrating evidence-based research, professional experience and perspectives of people with disabilities, in order to create more inclusive and sustainable communities.

Involvement of End-Users through Participatory Design Toolkits in the Design of Information Architecture for a Cultural Heritage Digital Collection

Participatory design toolkits are designed to involve users as active partners in the design process. In the design of information architecture (IA), there are only few examples in which participatory design toolkits were used. This study investigated how three different toolkits provided insights in IA design. The study was exploratory and based on three participatory workshop sessions engaging users in the development of IA design ideas. Two toolkits proved well suited in involving users, while the third toolkit provided fewer user insights. User characteristics, specifically IT competences, and time available influenced the use and outcome of the toolkits.

Customization and acceptability of the WHO labor care guide to improve labor monitoring among health workers in Uganda. An iterative development, mixed method study.

Cognisant of persistently high maternal and perinatal mortality rates, WHO called for adoption and evaluation of new adaptable and context-specific solutions to improve labor monitoring and health outcomes. We aimed at customizing/refining the new WHO labour care guide (LCG) to suite health care provider needs (HCP) in monitoring labour in Uganda. We used mixed methods to customize/refine and pilot test the new WHO LCG using stakeholder perspectives. Between 1st July 2023 and 30th December 2023, we conducted; 1)30 stakeholder interviews to identify user needs/challenges that informed initial modifications of the WHO LCG; 2)15 HCP in-depth interviews to identify any further needs to modify the LCG; 3) Two focus group discussions and 4) Two exit expert panels to identify any further user needs to further refine proposed modifications into the final prototype. Questionnaires were administered to assess acceptability. We interviewed 125 stakeholders with median age of 36 years (IQR;26-48) exposed to the LCG for at least 12 months with 11.8(SD = 4.6) years of clinical practice. Simple useful modifications/customizations based on format, HCP's perceived function and role in improving decision making during monitoring labour included; 1) Customizing LCG by adding key socio-demographic data; 2) Adjusting observation ordering; 3) Modification of medication dosages and 4) Provision for recording key clinical notes/labour outcome data on reverse side of the same A4 paper. All HCPs found the modified WHO LCG useful, easy to use, appropriate, comprehensive, appealing and would recommend it to others for labour monitoring. It was implementable and majority took less than 2 minutes to completely record/fill observations on the LCG after each labour assessment. Active involvement of end-users improved inclusiveness, ownership, acceptability and uptake. The modified LCG prototype was found to be simple, appropriate and easy-to-use. Further research to evaluate large-scale use, feasibility and effectiveness is warranted.

Assessment of Design Values in Designing Product Standards: A Design Study on a Sport PPE

Participation in sports requires using Personal Protective Equipment (PPE) to preserve athletes’ well-being. Although equipment may negatively impact performance, governing bodies often impose standards on participants subject to their jurisdiction. Although the vast majority of new products are incremental innovations, radical innovation still attracts design researchers' and professionals' attention. The design of complex systems needs the expertise of various kinds: designers are fundamental in conceiving innovations in response to developing ways of product use and customer needs, despite they must face product standards, which often act against product innovation. Despite product innovations benefiting consumers in many markets, they do not necessarily benefit consumers in sports PPE markets. In this paper, the author reflects on an ethnographic case study and the importance of the involvement of end and co-dependent users in the design of sports PPE. For this study, the design of the Australian safety vests for jockeys, frequently overlooked, was examined for incremental innovation and its relationship with its standards. This was inspiring to consider an assessment of design values in designing product standards in the sports field. As co-design is increasingly applied across multiple sectors, there is a huge need for practical design guides to support product development and co-designing with users. Further research in this field is highly recommended.

A Living Lab approach to understanding dairy farmers' technology and data needs to improve herd health: Focus groups from 6 European countries

For successful development and adoption of technology on dairy farms, farmers need to be included in the innovation process. However, the design of agricultural technologies usually takes a top-down approach with little involvement of end-users at the early stages. Living Labs offer a methodology that involve end-users throughout the development process and emphasize the importance of understanding users' needs. Currently, exploration of dairy farmers' needs of technologies has been limited to specific types of technology (e.g., smartphone apps) and adult cattle. The aim of this study was to use a Living Lab approach to identify dairy farmers' needs of data and technologies to improve herd health and inform innovation development. Eighteen focus groups were conducted with, in total, 80 dairy farmers from Belgium, Ireland, the Netherlands, Norway, Sweden, and the UK. Data were analyzed using Template Analysis and 6 themes were generated which represented the fundamental needs of autonomy, comfort, competence, community and relatedness, purpose, and security. Farmers favored technologies that provided them with convenience, facilitated their knowledge and understanding of problems on farm, and allowed them to be self-reliant. Issues with data sharing and accessibility, and usability of software were barriers to technology use. Furthermore, farmers were facing problems around recruitment and management of labor and needed ways to reduce stress. Controlling aspects of the barn environment, such as air quality, hygiene, and stocking density, was a particular concern in relation to youngstock management. In conclusion, the findings suggest that developers of farm technologies may want to include farmers in the design process to ensure a positive user experience and improve accessibility. The needs identified in this study can be used as a framework when designing farm technologies to strengthen need satisfaction and reduce any potential harm toward needs.

Reasons for the Failure of Most In-House Software Development in Tanzania: A Case Study of Selected Higher Learning Institutions (HLIs)

Since it has evolved into an essential part of today’s world, 90% of Tanzanian businesses have attempted to develop in-house software for their operations. However, a substantial fraction of these projects haven’t quite achieved what they set out to. The bulk of in-house software development projects in Tanzania have been unsuccessful. This article presents ideas for improving the success rate of in-house software development initiatives and explains why this is the case. As part of the qualitative research methodology, software developers, project managers, and other stakeholders took part in focus groups and interviews. The results show that there are several factors, such as a lack of qualified staff, an inadequate budget allocation, poor project management, a lack of precise project requirements, improper communication, an inadequate amount of resources, and a lack of user involvement, that significantly contribute to the failure of in-house software development projects in Tanzania. The study makes numerous recommendations for enhancing the success rate of in-house software development initiatives in Tanzania. Involving end users throughout the project life cycle, implementing strong project management practices, allocating enough time and resources for software testing, hiring experts to establish and gather precise project requirements, allocating adequate budgets, and setting up efficient communication channels are a few examples of these. Additionally, in-house software development must adhere to the SDLC’s standards by enhancing the model of the SDLC that best suits the nature of the development process.

Catalyzing Clinically Driven Undergraduate Design Projects at the Nexus of Engineering, Medicine, and Business.

Design projects, particularly those related to assistive technology, offer unparalleled educational opportunities for undergraduate students to synthesize engineering knowledge with a clinically driven need to produce a product that can improve quality of life. Such projects are most effective when engineering, clinical, and business perspectives are considered throughout. However, the logistics of successfully implementing such interdisciplinary projects can be challenging. This paper presents an auto-ethnography of 12 undergraduate design team projects in assistive technology performed by 87 students from five majors (including engineering, business, and clinical students) over the course of 5 years. The overarching goal of our work was to establish an undergraduate integrated design experience at a university in the absence of a dedicated biomedical engineering major. The focus of this experience was to foster the creation of student-led prototypes to address real-world problems for people with disabilities while keeping commercialization potential at the forefront throughout. Student participation demonstrated a clear enthusiasm for completing biomedical engineering-themed projects. To encourage the implementation of similar approaches at universities where a biomedical engineering major does not exist, we identify common obstacles that can arise and present strategies for mitigating these challenges, as well as effective approaches for catalyzing cross-disciplinary collaborations. High impact practices include close involvement of end-users in the design process; cross-disciplinary team composition (e.g., engineering, business, and health sciences students); and choosing cross-disciplinary leads for project management. Teams experienced a high degree of success with all 12 teams producing functional prototypes. We conclude that at universities that do not offer a biomedical engineering major, health-focused integrated design experiences offer students important interdisciplinary perspectives, including a holistic approach to project implementation. Furthermore, for many students, these projects ultimately served as a gateway to subsequent careers and graduate study in biomedical engineering.