 Now, so we talked about this various 16 steps. One thing I want to highlight is that in all the steps, right from defining to deploying, the role of doctors is very critical. In fact, call it as bedside to bench to business to bedside because you are identifying a need at the bedside of a patient, you are developing a solution on the bench side which is engineering, but then unless you go through business you cannot deploy it, but then it goes back to bedside again. So, bedside to bench to business to bedside is a cycle for a medical device innovation and every step the doctors had to be consulted and involved. Without them you cannot succeed, ideally multiple doctors. So, what I am going to share now with you is the pipeline or the process by which we are able to do the innovation, put the resources together and take it all the way from bedside to bedside again. It starts from Medha which is medical device hackathon. What we do is, you know, whole year we keep getting doctors who are saying solve this problem or solve that problem. So, we make a list of those problems. We also get a lot of applications from students or working professionals saying that we want to try this area out. And third, we have several institutions who say that we want to initiate or start a medical device innovation cluster. So, what we do is we put all the things together and we organize a series of hackathons called as medical device hackathon which is a two-day affair. Starts on a Saturday morning and ends on a Sunday evening and we bring those institutions. We do it in some other place and those people who want to work in this field and doctors who said we want to take up some problems, we bring all of them together. And typically we do it in May, June, July, August months and those who after doing that some of the working professionals or winners of those events, Medha events especially those who want to take go forward one more step forward. They want to equip themselves with the right kind of skills and contacts and so on. We bring them to what is called as medical device innovation camp or medic. We typically do it in end September or early October. And this is a one-week affair. So, we start on a, let's say Friday evening and or it's a Friday morning. So, Friday, Saturday, Sunday, Monday, Tuesday, it goes for five days. And five days and four nights. Usually we have people not sleeping on the fourth night, so they're trying to push the whole thing. But many times happens that people start losing sleep from day one itself. And but those who withstand that training and pressure and able to build something in five days, four nights, we usually invite them or they usually come themselves for a fellowship in Betik. It's a one-year fellowship. Usually we sometimes extend it for one and a half years. But in one to one and a half years, they're supposed to develop a complete medical device, test it in the lab, maybe even preliminary testing in the hospitals and go to the next step, which is put it in an exhibition, medical device expo, MedEx. So, we organize our own MedEx twice in a year. But we also put in other exhibitions organized by other government and private organizations. Now, in exhibition, what happens is when people are coming and saying, hey, I like this device, what does it do? Can I get a, can I buy this? Or some distributor says, I would like to partner with you. Or some doctor says, this is fantastic. I want to talk about it or test it. Then you just start getting the validation that what you're done is something very nice. And that is the stage when you go to the next step, which is actually start a company. What is happening is many people, young people start a company. Then they start developing device. Then they are to pivoting, meaning changing the design or market or customers, okay? Then trying to find partners and buy time and run out of money, okay? Then they end up giving a lot of equity to private companies or venture funding. So it's not a, we feel a better way is to do as much as possible before. And once you start a company, you should be able to start selling in year one, not developing, developing for two, three years. So typically what we say is from bedside to bench to business to bedside. We should be able to traverse the entire pathway in three years time for a low risk device. So these are pictures of the hackathons that we have done. Medical device hackathons in different places. They are in Bombay, Pune, Nagpur, Kolhapur, Varda, different places. We have done about 11 of those. And then we also do medical device innovation camp. The first one we did in IIT Bombay in 2015. Then we cycled it to Pune and Nagpur, came back to IIT Bombay last year. And this year also we did in IIT Bombay only. And these are all teams of, remember four people. Every team has a doctor, a designer, a mechanical, a electronics engineer. And so we give them basic lectures. We give them interaction with domain experts, doctors, patent lawyers, regulatory experts. We have night fireside stories. And their stories are so inspiring that these people want to actually work on devices through the night. And finally we have a spotlight on the last day when they actually present their ideas. What they done on four days, four nights to a jury room full of 100 jury members. Top doctors and industry people and investors and so on. And usually it is a game-changing, life-changing experience for everyone. So the people who are working in BITIC over the last few years, this is the current team. They all have come from previous MEDHA and MEDIC like that. So either they attend that or they participate in that. They are Vanda things. And then they usually leave their current jobs and then come and join because they think this is the, they want to make a contribution, make a difference through medical device innovation. What they have done in the last four or five years is amazing. About almost 16 to 20 products. You look at diagnosis, monitoring, screening devices, surgical instruments, your assistive rehabilitation devices. You literally head to toe has happened in BITIC in the last four years. And within among them, if you see, notice the red ones are the startup companies. There are 10 startup companies. And then there are blue ones are licensed to Indian industry. So some company has come saying, okay, we will manufacture that and we'll transfer technology to them. And you also see green stars. The green star is the Biotechnology Ignition Grant or BIG grant of 5 million rupees. 10 times BITIC people have won that. Plus there are five more companies started by BITIC innovators which are not in this list. So total 15 startup companies and five licensed to industry. So 20 you can say is an impact of BITIC. So let me give you two of the stories out of this whole thing. The first story I pick up is the story of Tapas and Adarshah who joined hands with a, at that point, a rural hospital doctor called Dr. Nambir Raj. So these three were participants in MEDIC 2015. They all got together for the first time. And the doctor said that when I put a stethoscope on the chest of a patient in my rural hospital and I hear an unusual sound, I do not know whether it is an emergency or not. Should I send the patient immediately to city hospital or district hospital or not? I wish I can somehow send the sound to my friend in Pune or Nagpur or Mumbai and get a second opinion. Remote Oscultation. Oscultation means hearing the chest sounds. Remote means hearing the sounds of patient who is not in front of you. So can you believe that in four days and four nights these people built a prototype and Tapas was in the audience put a stethoscope on his chest, Adarshah was on the stage and on the loudspeaker you could hear Tapas heartbeat. So they won the competition, MEDIC competition. But instead of going back to their companies, they were both working at that point of time. A few months later, they resigned from their jobs, came to IIT and said we want to take it up full time. And so we put them in touch with hospitals, Forte's Hospital, Hinduja Hospital and so on. Within a year's time, they developed a proper prototype which is self-contained and developed the electronic circuitry for that to enhance sound, cancel noise and they can record it using a output to a mobile device and of course you can transmit to mobile to someone else. The audio file can become part of the health record and you can see that they can start doing analytics. They can now start distinguishing between unusual heart sounds, a murmur or unusual lung sounds let's say a wheeze or a cough. Okay, they filed a patent, they continued to work with the doctors. They applied for the BIG grant, they won the grant in 2017. Right after that, they started a company. Last year, December, 2018 December, they went to rural camp and we had to screen a lot of patients for chest and heart sounds. And within a year, one year of starting the company, they had sold more than 500 units of the device. Various companies, doctors, hospitals, telemedicine companies, rural primary health care centers and so on, they are now going very strong. So this video shows you that how they got together, how they work together, developed the product, they took it to market, the startup company, what difference they are making, all these are shown in that. Let me tell you one more story like that. This is a story of multiple innovators at Betik. He started from one student called Amit Maurya, mechanical engineering student. And Dr. Rajni is a director of Center for Human Movement Science in MGM Hospital in Navi, Mumbai. So she said that many patients come to her with what is called as diabetic foot neuropathy. Now diabetes, you know, is affecting like 60 million people in India. That order, more than that. And apparently 10% of them will develop what is called as diabetic foot neuropathy. What it means that the nerves and the blood vessels in the foot are now damaged, they don't work. So when you step on a stone or damage your foot in some way, you don't feel the pain because nerves are damaged, but then it won't heal either because now this blood supply is not there. So it eventually, infection becomes gangrene, gets infected and eventually the foods are amputated. And apparently at this point of time, every 30 second, someone's foot is being amputated. It could be toe, it could be the entire leg, okay? And remember that maybe half the diabetics are in India only, or at least one third are in India. So maybe every minute or every two minutes, someone's leg is being amputated because of diabetes complications. Now it is still not making it to newspapers, but it will become big headlines before you know, okay? So the doctor told that this is important and he said, okay, let us start doing something to prevent the amputations by predicting that this patient is susceptible to diabetic foot neuropathy condition. And so it devised to screen the patients. There are devices, but they are cumbersome. They take time, they are subjective. It depends on the patients and doctor's opinion. So you want to make something which is objective. Scientifically, it works by itself. So create the first version of that, went to some hospitals, demonstrated that doctors gave a lot of feedback and evolved version two and three and four. As you can see, each version is different. And then the student left and he joined some other startup company. Then he got someone else called Nishant Kathpal, who is a electrical engineering graduate of IIT Bombay again. And he took the project forward, devised, developed a much more comprehensive, much more smarter, much more faster device. He added more functionality to the whole thing. And eventually he also applied to the BIG grant and won the award, started a company called as Ayathi Devices. And recently we have also launched it in the medic event. I am Dr. Kakodkar Ji and our director for Subhashish. What I hear from Professor Ravi is that business is something like 40,000 crores annually. That's what we import. And so there is a huge scope. But beyond that, I think for a country as a whole in the high tech innovation, again I think that it represents an excellent, more accurate, and of course, I must thank IIT Bombay. And now it is making headlines. So we have Times of India and other papers that covered it nicely. So now this man is now taking off on this entrepreneurship journey. So Steemu stands for stiffness measurement unit. What he found is that instead of looking at just the touch and temperature sensation, what is what doctors do, we will actually send a probe to find how hard or soft the tissue is. And apparently the tissue stiffness has a very high correlation with possible diabetic foot. When the entire foot can be scanned, there are special points where you can see where the high points, that is where you need to probe and see whether that is susceptible to diabetic foot or not. The whole thing can be done in a fraction of the time of what it takes by a normal way of doing it. And patient can stand. It doesn't have to be lying down and so on. And he has two versions. One home unit which you can be used by patients or by let's say, GPs, general practitioner doctors. And one for let's say, diabetiologists or diabetes specialists. So a lot of advantages for the whole thing. And this technology is now going forward to this startup company. The next story I want to share with you is the story of Anish Karma. And he is a polio victim himself. And he said that when polio victims either have to place a hand to prevent buckling or the wear what is called as a calipers. Technical name is knee ankle foot orthosis, CAFO. Now CAFO comes in only two versions mostly. You have one low end version which is supplied free of cost in government hospitals, which is rigid. For sitting you just unhook the whole thing and just a little dangle and you can sit down. But you can't even that sitting thing is only 90 degrees. You can't squat on the floor. You can't cycle with that. Whereas the high end devices cost you lakhs or rupees, millions or rupees. And those have electronics and power packs and hydraulics and so on. So if something goes wrong, you cannot use it anymore. So what this man said is can I have something in between? Something which makes me walk little more naturally like with a knee joint and so on and lightweight and give support but not expensive like the high end ones. So he would go to, he took a free calipers from a government hospital but started going to a local cycle shops. Started doing welding and modifying saying that I just, and he's not even an engineer. He's not even passed his 12th exam. So he started innovating himself. Eventually got in touch with Betik. We invited over here and you can see it from version one. He has progressed to version two and three and four. Far more aesthetic, far more functional, far lighter weight. Easier to manufacture. It won't tear clothes and you're putting now some more covering to the whole thing and so on. And now it's progressing to a stage that you can commercialize that. And that's the stage when he also got in touch with Dr. Rajini again. So using the gate lab which we already have, we walk on the platform and we are seeing whether it is closer to a normal human gate or not. Remember this is the first time that he's wearing his own calipers. And remember he's walking without putting his hand and he's walking more naturally. He's not like, leg is not rigid leg. Although it is, you can see that there's a bit of not natural walk but we'll get there eventually. Then he started winning awards. Lot of awards in handicapped category, design category and he also recently got a BIG award and that money has now gone to start his company which is called as Amish Technologies. And this is again a bit of video of how the functionality of the whole thing. As you can see, he's able to not only walk, he'll be able to squat. Look at the angle, almost close to zero degrees. He's able to walk. And eventually you'll see him even cycling. So patient, he's an innovator and innovator became the entrepreneur now. That's the story of Anish Khan Karma. The next story I pick up is a student from College of Engineering, Pune, COEP. And the local doctor, Dr. Anish, Ashish Ranadev, he said that when children break their bones in the school, usually put a splint to immobilize that until they go to hospital. But imagine that happening on a highway or in a farm. So you have to immobilize the hand until you go to hospital and then they'll put a plaster. So you need something in between before you put a plaster. That could be for, in between, could be for a few hours, could be even for a few days. Now, how do you solve the problem? So what he came up with is that, he said I'll make a hybrid splint. It's made of a combination of materials, paper and plastic and tissue and cotton and so on. And you dip it in water. You shape it around the zone where fracture is there. And within minutes it becomes rigid or hard in air. Okay, so it becomes like a splint and you can now go to hospital. It'll hold your hand until you go to hospital. Again, he has gotten very good response from potential partners, distributors and so on. One distributor is actually speaking to them, as we speak, to take it all over the country. He is looking at designing machines to make it in, rapidly in, at a low cost. So imagine that it can be deployed in every hospital, every school, every sports facility, wherever you, wherever possibility of fracture is there. He also got a BIG award. He also filed his patent. And the patent is licensed to his own company, which is called as MediAsha Company. Two more stories I'll tell you, which is one, two of instruments. So I've been talking about diagnosis and treatment and assistive devices. But what about surgical instruments? This is one story of Sreetham, who is from IIT, he later on went to Johns Hopkins and now he's in a US company. But when he was here for two years, he worked with a one doctor called Dr. Suresh Deshpande. Now, Suresh Deshpande has trained thousands of laparoscopic surgeons. Laparoscopic surgery is that, if you have anything in your abdomen, could be appendicitis or gallbladder or kidney problem, whatever, instead of making a big cut, they can just send an instrument through the navel, small cut. And through the instrument, they can do surgeries. Now, because now you're not doing with your hand, you are only holding a handle and surgery is happening at the end part of the handle. Imagine that. An end part has only one degree of movement. You can either grasp it or cut it. But what if you want to switch ring? Not possible or very difficult. So what doctor said is, can you give me a wrist at the end of the instrument? Can you make the instrument have more degrees of freedom? So Sreetham started with that. Initially, the paper concept, literally, and 3D printed concept and metal prototypes. Metal prototypes of different categories. Finally, he went to a stage that the device could be now demonstrated and making these metal parts was a big nightmare for us. Very fine metal parts. And the doctor said, I should be able to sterilize the equipment again and again and you reuse that. And sterilizing means that you cannot have wires because wires will become loose. So all the rigid links and how we developed that is a mystery. Development and manufacturing was a big challenge. And but fortunately, a company came forward called Eclipse Instrumentation in Thane. And they said that we were looking for something like this to commercialize and take it forward. So they licensed the technology. We have given the whole details, the drawing, the bill of materials, the how to make it, all the training for them. We have helped them to make first few batches of the parts and they're now gearing up for mass production and marketing of the device. So this is one more example of instrument. One last example, perhaps I want to give you is a biop cigar. Whenever there's a tumor in the body, you want to know whether tumor is benign or malignant. And so what you do is, as a tumor is suppose inside the body somewhere inside, you want to, you can't, you want to take a sample to test it. If it's malignant, then you have to remove the entire tumor, but it's benign, you can leave it off. Generally, body will take care of itself. Now you need to sample the tissue. That is done using what is called as a biop cigar. You send a needle inside the body and it will suck out, cut out a piece of the tissue, bring it out safely and you put it under a microscope to know whether it is malignant or benign. Now the thing is, the existing devices were single use. You use a device, get the sample and throw the instrument out and build some 3,000, 5,000 rupees to patient. What a doctor said is, why am I wasting the instrument? Why can't I reuse the instrument? Why can't I just throw the needle and needle can be made for 100, 200 rupees. So we started on the journey. We made the first device. You can see a device, how the design is changing through the CAD model to physical first prototype, second prototype, third prototype, made more easy, more ergonomic, more easy to adjust, handle, all those things. And again, one more company called as Tenon, Meditech and Pune. They came forward and said that we want to license this device and we want to do mass production. They were only looking for developing something like that. Fortunately, we had developed already. So they joined hands and whatever we had developed, we gave it to them and after that they modified it slightly more with our help only and then we will be ready for mass production and marketing. So as you can see, these stories are part of a larger canvas of doctors working with engineers. And these are all our happy pictures. Most pictures will have a doctor and an engineer and some pictures will have a patient also. Meditech's exhibition. Exhibition is very, very important for us. It's an asset test to know whether this device should be commercialized or not. Final asset test, put in exhibition, you have all the stakeholders, distributors, doctors, patients, possible patients, investors all coming there. If they show a lot of interest, then you know that it's time to start a company. And we have done 15, 20, either our own exhibitions or we have put in exhibitions of other organizations. And exhibitions means also means press coverage. So we have had press coverage in all major national mainstream media, also social media, we have online media, we have TED talks, we have things like Forbes India and business outlook. So we have been covered fairly well. What it does is that, one is it gives a incentive to the innovator himself or herself, who is like an incentive. It's like they feel good that, okay, I've done something which is valuable and interesting to society. Number two, it attracts potential partners, doctors, investors, distributors, and so on. In fact, the first order for the stethoscope came from a IAS officer in Gujarat who read the article in a business outlook or Forbes magazine. And he read that and made a phone call saying that I heard about it. Can you come for a demonstration? So we get contacts through, sometimes through media outreach like that. So it's very valuable to have a media presence in a nice way. And also the stories of the medical devices innovated at Vedic, 16 stories of them along with the 16 steps which I talked to you about. Those 16 steps, all illustrated by 16 stories are there in this book called Essence of Medical Device Innovation. And also the best practices of every step. I mentioned to you that we have standard operating procedures, we have forms, we have records. All these things are now being captured in a, what's called as the ISO 13485. It is like ISO 9001 for medical devices. Far more difficult than ISO 9001. But we finally got a certificate for Vedic. We got the verification or server list or it also done successfully. So we are now authorized to develop medical devices. And what the certificate means that we are doing it in a systematic manner. Anytime anyone wants any detail, there's a written record of how we are done, what we are done and why we are done something. And today Vedic is no longer one center in one place. We, as I mentioned to earlier, Vedic was earlier established in three places immediately after IIT Bombay, in Vietnam in Nagpur and College Engineering Pune. But right after that, in the last three years, we have had four more engineering colleges. KJ Somya College Engineering in Mumbai, MIT Arts Design Technology University in Pune, Simba's is International University in Pune, and GH Raishwani College Engineering in Nagpur. These four also set up their own self-sufficient Vedic cells. We also have now five, six hospitals. Plus we have agreements with Sinai, IIT Bombay, Venture Center, Pune, agreements or arrangements so that these innovators can start companies in these incubators. And various governments are also taking our help to create the innovation entrepreneurship ecosystem in those states. So if you look at the overall summary of what we have achieved so far, we have now 14, 15 centers. We have more than 100 doctors who are continuously engaging with us. More than 50 innovators who have gone through the process, Vedic fellows who have invented something, many of them either licensed the technology to a company or to their own startup company. And therefore we have like several startup companies. More than 600, 700 people trained through Medha and Medic. So they now know medical device innovation. BIG awards 10 times. Similarly, there's another big award called as DST Lockheed Martin, India Innovation Growth Program Gold Medal. That we got three or four times. And then Google Challenge Award and many other awards which I've not even counted. But that is not a happy thing. The real happiness comes from the fact that we have a technology created and IPRs rights secured, patents filed, 50 patents filed and six filed internationally, 20 products developed, 15 startups and file licenses to industry and more than 1000 patients. And this number is going very rapidly now who have been touched and benefited by these devices. So the question is now how did it happen? What is the secret ingredient or secret sauce for the whole thing? When people ask these questions, so we try to boil it down to something which is easily understandable and implementable also. So we say that the DNA of medical device innovation has four strands. One strand is of people, the doctor, the researcher, the entrepreneur and the investor. The place strand, doctor in hospital, researcher in institute and so on. And then the two other strands are the process strand defined, developed, deliver and deploy. And then the purpose or outcome strand which is the first one is concept, second stage you get a prototype, third stage you get a product and the fourth stage you get an application of the product in the market usage. We call this as ideation, invention, innovation and impaction access. That's the DNA of medical device innovation ecosystem as we implemented at Betik. The other secret sauce is that you need to create the right kind of a facility. One is a hardware, equipment. You need prototyping in plastic and metal and electronics and software, that definitely you need. And ideally if it's certified ISO 13485 or ISO 9001, it is great because then your system's in place. The second layer is about the people in the centers. You definitely need people of different disciplines and branches because innovation requires collaboration between different disciplines, I've been telling you that. So you need that. And ideally visitors and faculty and experts and technicians, they're all coming in and you need all kinds of expertise for that. But the most important thing is the culture part of it. And I want to highlight once again that innovation is driven by collaboration. Collaboration means going out of comfort zone and that means reduced ego. And that is possible when you focus on the end user which is a patient in this case. A patient in suffering, a patient in pain. If you keep that in your laser focus, that laser focus gives you the energy to go out of the comfort zone and do something wonderful. So I'll end with this last slide by saying that finally if you want the right results in life, this is applicable to anything of course. But if you want the right results in life, you have to put in the right action. Right action comes in the right vision. But vision is very dicey thing, very difficult to grasp. But easier to understand is that if you have the right intentions, you'll automatically have the right vision. If you have the right vision, automatically you'll have the right actions. If you're done these things right, you do not have to worry about results in any case. Life will be okay. Thank you very much.