 the field and it sort of would be not only that you would be able to help people in Armenia but also you're able to engage our youth and to sort of come up with a system that would hopefully allow us to think about problems, think about solutions and how we could execute those solutions in Armenia by Armenians and for the Armenian people and also others. So this is one of the biggest incentives for me that you know to engage students in Armenia and to engage institutions which thanks to Dr. Degrelevian, thanks to Dr. Hajian and Sarkis that they were so receptive of you know our proposed work and you know I feel like I've known Sarkis forever and you know it's been a pure joy to work with him and the students you know Dagi, Bahad, you know Levon so Dagi so this has been a wonderful experience for me. So at the same time that we were having these Armenian discussions about you know the lack of or to be caring Armenia which is quite a bit and then part of it is because implants and devices are so expensive and Armenia is not actually large enough as a country that you know warrants a lot of these companies to come in and set up shop in terms of you know having you know representatives and things of that nature it's just not a big enough business for them and so this leaves the landscape a bit barren and also allows for you know things not to develop in a proper way and what we I mean what I tasked myself with was that I will try to do whatever I can to rectify that situation make it make change for the better and also to engage with the folks in Armenia which is the students and also the orthopedic surgeons and everyone in all the processes in between that we need to engage with to make things happen. So along those lines while we were working to think about these things my colleague about Dr. Rodriguez we were thinking about orthopedic care in developing world as well himself having a heritage from South America and what we can do for the developing world to have access to proper orthopedic care that they currently don't that are basically either priced out or their you know resource constraint that you know they would not be able to have the same care as you would get in you know United States or in the Western world. So one of the biggest problems that we have let's say here in the United States is like you know with geriatrics in trauma you know most of the cases when you look at the company there must be geriatric folks older folks that you know fall and break ahead or things of that nature. So the hip is your largest bone in your body the femur and it's a significant load bearing bone. So most you know as you can imagine you stand you walk everything is done by transfer of load through your femur down here to the ground. So when it breaks it's a catastrophic event and with the best of care in the United States people that break their hip and they end up with a total hip surgery with best of care and everything up to 25 to 30 percent of them die within a year after surgery because they're mostly older folks. This is a massive trauma to the body and even with good care it's still a significant trauma to overcome. So and in situation Armenia is significantly worse I can tell you that and that's what really bothered me to think of that you know our you know momics and thoughtings you know that would be you know suffering and do not have the proper way to be cared for and so and that's how the idea of this short meal came about it's a very very common orthopedic implant that is used here you make it it's a relatively small surgery it takes less than an hour to do a surgery and you go from a broken hip to be able to put load on it and go back to normal life. So this is a so this is not a total hip surgery just so you know this is basically you put your bones back together so that you can function again and you know because your femoral head is impact your femoral neck is probably might be broken but everything is there there's you know you can sort of bring everything together secure them together and then allow the patient to to pay it load. So this is where sort of the incentive came up and if you look at these you know there's a number of companies that make these you know short nails in the United States and also in Europe and they're you know they're rather complicated complex cases and complex sets and have many many parts in them and they're very expensive you use some of them and then you have to restock them and you restock them and you have a representative from the company that's always available at each hospital so there's a significant amount of overhead that's associated with this process that quite frankly does not add much to the overall care and so we started thinking about how we could do this process and how we can simplify that and given you know Dr. Rodriguez's experience with it as a surgeon for like 10-15 years he had noticed that basically of all these different sizes and variations and everything that comes with these kits he basically ends up using a few options for about 90% of the time so and this is in the United States but you know at atomic variation is significantly larger than places that are much more homogeneous such as Armenia which you know pretty much rest of the world tends to fall in this category you know most people are you know in the smaller countries you know they're that you know ethnically uh similar and there's not a lot of size variation as you would see in a place such as America and so we ended up as we started to think about how we could change this process and came up with a solution to sort of use innovation not necessarily in a way that you normally associate innovation with is like some new and you know sort of a large idea but to take what's available and make it much more user-friendly and be just as good but also make it so that you could use it in a in a limited and resource constrained setting and that's where the innovation component came here and that's what we wanted to to emphasize so we went from a kit that basically has two trays and I'm sure that one will show you some information before after at some point and which you know 60 70 pieces in that kit to something that we could conduct this operation with less than 10 pieces in the kit so that was a sort of you know using a lot of you know sort of interchangable part using a lot of parts that carry on more than one task and be able to allow the surgeon to do this work relatively easily and also basically bring the price down so that you have a system that is cost effective is effective and also can therefore can be used by a large number of orthopedic surgeons for a large number of patients if you look at like the patient volume in Armenia and orthopedic care it's what really is sad for me is that you know the number of cases of different you know there's big surgeries that happen in Armenia are pretty much on par with what happens in my hospital for a whole year you know I understand it's a much smaller country but the bottom line is care is not given simply because it's you know not that the doctors are not good simply because it's out of most people's price range and it's difficult for them to get proper care and that's to me that's a tragedy and that's something that we must and should do something about so that came to the idea and I talked to Aram and he was kind enough to put me in touch with psyches and then we started working on this project with a number of students over the past couple of years and now we have come to work with Levon who actually did quite a bit of work and he continues to do work on this as part of his capstone project to sort of create the initial design that we had go through a series of optimizations and modifications and then actually make some of these parts in Armenia and then conduct some testing on them and do some final government analysis basically to satisfy the ASTM guidelines which govern all of these parts that you have to sort of make and produce in America so our goal is to design a system that would stand in the same regulatory rigor that would have in the United States and basically would be good enough to use in any western country to be used by in Armenia and also other developing nations so our goal is not to cut corners our goal is not to reduce quality for the sake of price but rather be smart enough about what we can do and how we change the processes and the designs so that allow us to be cost-effective yet be effective and also fulfill all regulatory sort of benchmarks that need to be done so this to me this is a wonderful component and and this is where actually Ed comes in and as part of a multidisciplinary team because anything that I do in my projects regardless of what project I work on I always have a team associated with it and there's a number of people with a wide array of expertise that are needed for each project and I'm thankful for all of them that be pulled together and we'll work together and here you know we have Sarkis's expertise from an industrial engineering perspective and me from a biomechanics perspective however I have no knowledge of how things work in an orthopedic company or any kind of a you know device company when you take the idea and you turn it into a product that you could put in people and that's where Ed came in and given his expertise and background and currently working as an involvement engineer for a biomedical field in Armenia was allowing us to take this idea and make sure that it turns into something that you can actually be used in patients so the regulatory processes are important and by the way they are minimal in Armenia because there's not a unfortunately large segment that you know is developing any kind of devices for the for biomedical use so as we go through this process this is truly a learning experience not only we have to design and optimize the system go through all the rigors of regulatory testing but we also have to establish this system in Armenia and give this and have this be accepted by by the government in Armenia by the orthopedic surgeons in Armenia and by the population because if somebody has the meme they will just say you know what forget about it I'll just buy a German product or whatever that comes from Europe we'll use that for my surgery our goal is to truly also change that mindset that what you make in Armenia and be accepted to another product in the world and with that comes a lot of hard work and a lot of dedication and also the ability to change people's minds so that things that we make in Armenia are of high quality and are done properly and that goes you know through the process of you know following standards and rigors that used that are used in the western world it's it falls on the shoulders of all of you our students that you know you guys are bright and wonderful students and truly one of the biggest joys for me is to come to AUA or go to any university in Armenia and spend time with our students it's I I'm not just giving you a cheap compliment but it truly brightens my day every time I get to do that and it invigorates me into like you know you know we have a bright future because of you guys and and I think it's it's upon us to not only design a good product but also show to our people that this is a wonderful product that is usable and I will be happy to use that should any of my family members need this kind of surgery so I think this is one of the other important parts of it and the other part is that you know falls outside of the expertise of all of us that we are in this group which is the sort of the business components the development component you might have a great product but if you don't have the means and the ability to show this and to come up with a proper business plan to come up with the proper marketing plan you're dead on arrival so this is why the multidisciplinary approach is really really essential to our success and those are the areas that we need to be working on to get this product that we have right now from the paper and testing into an actual product that can be tested and marketed and used in Armenia and hopefully other similar companies so that