As a parent, you absolutely dread that call from your child indicating he or she has a problem—maybe a huge problem.  On April 25th of this year we received a call from our oldest son.  He was taking a late lunch at a local restaurant in downtown Chattanooga when he suddenly collapsed, fell backwards and hit his head on the sidewalk.  An onlooker rushed over to help him and quickly decided he needed a visit to Memorial Hospital emergency room.  Something just did not feel right.  He called us on the way to the ER. Once in the ER and after approximately five (5) hours and one CAT Scan later, the attending physician informed us that our son had a great deal of fluid collecting at the top of his brain and there was a great deal of swelling.  The decision was made by them to move him to Erlanger Hospital.  Erlanger has better facilities for neurological surgery if that became necessary.  At 1:32 A.M. Wednesday morning we received word that our son had a tumor at the base of his brain stem.  It was somewhat smaller than a tennis ball and in all probability, had been growing for the last ten years.  Surgery was necessary and quickly to avoid a stroke or a heart attack.  The tumor was pressing on the spinal cannel and nerve bundles.  Much delay at this point would be catastrophic.  It is amazing to me that there were no signs of difficulty prior to his fall.  Nothing to tell us a problem existed at all.

Erlanger referred us to the Semmes-Murphy Clinic in Memphis where all documentation from Memorial and Erlanger had been sent.  Founded one hundred (100) years ago by Eustace Semmes, MD, and Francis Murphey, MD, Semmes-Murphey Neurologic & Spine Institute has been a leader in the development of technology and procedures that improve the quality of care for patients with neurological and spine disorders. This continuing leadership has made the Semmes-Murphey name instantly recognizable to physicians across the country and the world, many of whom refer their patients here for treatment.  Dr. Madison Michael performed the eight (8) hour surgery nine (9) days ago to remove the tumor.  He is a miracle worker.  The surgery was successful but with lingering issues needing to be addressed as time allows and physical therapy dictates. Our son has lost hearing in his left ear, double vision, some atrophy in his extremities, and loss of stability.  There was also great difficulty in swallowing for three days after surgery and at one time we felt there might be the need for a feeding tube insertion.  That proved not to be the case since he eventually passed the swallow test.  That test is as follows:

  • Water
  • Applesauce
  • Jell-O-like substance
  • Oatmeal
  • Solid food

He did eventually pass.

We have a long road of recovery ahead of us but there is optimism he can regain most, if not all of his cognitive and physical abilities.  We do suspect the hearing is gone and will never return, but he is alive.

CRANIAL NERVES:

Our brain is a remarkably delicate and wonderful piece of equipment.  The ultimate computer with absolutely no equal.  Let’s take a look.

The cranial nerves exist as a set of twelve (12) paired nerves arising directly from the brain. The first two nerves (olfactory and optic) arise from the cerebrum, whereas the remaining ten emerge from the brain stem. This is where our son’s tumor was located so the surgery would have to be performed by one of the very best neurosurgeons in the United States.  That’s Dr. Michael.

The names of the cranial nerves relate to their function and they are also numerically identified in roman numerals (I-XII). The images below will indicate the specific location of the cranial nerves and the functions they perform.

You see from above the complexity of the brain and what each area contributes to cognitive, mobility and sensory abilities.  Remarkably impressive central computer.

The image below shows the approximate location relative to positioning of the nerve bundles and the functions those nerves provide.

 

 

Doctor Michael indicated the nerves are like spider webs and to be successful those nerves would have to be pushed away to allow access to the tumor.   The digital below will indicate the twelve (12) nerve bundles as follows:

Olfactory–This is a type of sensory nerve that contributes in the sense of smell in human beings. These basically provide the specific cells that are termed as olfactory epithelium. It carries the information from the nasal epithelium to the olfactory center in brain.

Optic–This is a type of sensory nerve that transforms information about vision to the brain. To be specific this supplies information to the retina in the form of ganglion cells.

Oculomoter–This is a form of motor nerve that supplies to different centers along the midbrain. Its functions include superiorly uplifting the eyelid, superiorly rotating the eyeball, construction of the pupil on the exposure to light and operating several eye muscles.

Trochlear–This motor nerve also supplies to the midbrain and performs the function of handling the eye muscles and turning the eye.

Trigeminal–This is a type of the largest cranial nerve in all and performs many sensory functions related to the nose, eyes, tongue and teeth. It basically is further divided in three branches that are ophthalmic, maxillary and mandibular nerve. This is a type of mixed nerve that performs sensory and motor functions in the brain.

Abducent–This is a type of motor nerve that supplies to the pons and performs the function of turning the eye laterally.

Facial–This motor nerve is responsible for different types of facial expressions. This also performs some functions of sensory nerve by supplying information about touch on the face and senses of tongue in mouth. It is basically present over the brain stem.

Vestibulocochlear–This motor nerve is basically functional in providing information related to balance of head and sense of sound or hearing. It carries vestibular as well as cochlear information to the brain and is placed near the inner ear.

Glossopharyngeal–This is a sensory nerve which carries sensory information from the pharynx (initial portion of throat) and some portion of tongue and palate. The information sent is about temperature, pressure and other related facts. It also covers some portion of taste buds and salivary glands. The nerve also carries some motor functions such as helping in swallowing food.

Vagus–This is also a type of mixed nerve that carries both motor and sensory functions. This basically deals with the area of the pharynx, larynx, esophagus, trachea, bronchi, some portion of heart and palate. It works by constricting muscles of the above areas. In sensory part, it contributes in the tasting ability of the human being.

Spinal accessory–As the name intimates this motor nerve supplies information about the spinal cord, trapeziusand other surrounding muscles. It also provides muscle movement of the shoulders and surrounding neck.

Hypoglossal–This is a typical motor nerve that deals with the muscles of tongue.

CONCLUSION: I do not wish anyone gain this information as a result of having gone through this exercise.  It’s fascinating but I could have gone a lifetime not needing to know.  Just my thoughts.

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Biomedical Engineering may be a fairly new term so some of you.   What is a biomedical engineer?  What do they do? What companies to they work for?  What educational background is necessary for becoming a biomedical engineer?  These are good questions.  From LifeScience we have the follow definition:

“Biomedical engineering, or bioengineering, is the application of engineering principles to the fields of biology and health care. Bioengineers work with doctors, therapists and researchers to develop systems, equipment and devices in order to solve clinical problems.”

Biomedical engineering has evolved over the years in response to advancements in science and technology.  This is NOT a new classification for engineering involvement.  Engineers have been at this for a while.  Throughout history, humans have made increasingly more effective devices to diagnose and treat diseases and to alleviate, rehabilitate or compensate for disabilities or injuries. One example is the evolution of hearing aids to mitigate hearing loss through sound amplification. The ear trumpet, a large horn-shaped device that was held up to the ear, was the only “viable form” of hearing assistance until the mid-20th century, according to the Hearing Aid Museum. Electrical devices had been developed before then, but were slow to catch on, the museum said on its website.

The possibilities of a bioengineer’s charge are as follows:

The equipment envisioned, designed, prototyped, tested and eventually commercialized has made a resounding contribution and value-added to our healthcare system.  OK, that’s all well and good but exactly what do bioengineers do on a daily basis?  What do they hope to accomplish?   Please direct your attention to the digital figure below.  As you can see, the world of the bioengineer can be somewhat complex with many options available.

The breadth of activity of biomedical engineers is significant. The field has moved from being concerned primarily with the development of medical devices in the 1950s and 1960s to include a wider ranging set of activities. As illustrated in the figure above, the field of biomedical engineering now includes many new career areas. These areas include:

  • Application of engineering system analysis (physiologic modeling, simulation, and control to biological problems
  • Detection, measurement, and monitoring of physiologic signals (i.e., biosensors and biomedical instrumentation)
  • Diagnostic interpretation via signal-processing techniques of bioelectric data
  • Therapeutic and rehabilitation procedures and devices (rehabilitation engineering)
  • Devices for replacement or augmentation of bodily functions (artificial organs)
  • Computer analysis of patient-related data and clinical decision making (i.e., medical informatics and artificial intelligence)
  • Medical imaging; that is, the graphical display of anatomic detail or physiologic Function.
  • The creation of new biologic products (i.e., biotechnology and tissue engineering)

Typical pursuits of biomedical engineers include

  • Research in new materials for implanted artificial organs
  • Development of new diagnostic instruments for blood analysis
  • Writing software for analysis of medical research data
  • Analysis of medical device hazards for safety and efficacy
  • Development of new diagnostic imaging systems
  • Design of telemetry systems for patient monitoring
  • Design of biomedical sensors
  • Development of expert systems for diagnosis and treatment of diseases
  • Design of closed-loop control systems for drug administration
  • Modeling of the physiologic systems of the human body
  • Design of instrumentation for sports medicine
  • Development of new dental materials
  • Design of communication aids for individuals with disabilities
  • Study of pulmonary fluid dynamics
  • Study of biomechanics of the human body
  • Development of material to be used as replacement for human skin

I think you will agree, these areas of interest encompass any one of several engineering disciplines; i.e. mechanical, chemical, electrical, computer science, and even civil engineering as applied to facilities and hospital structures.

THE NEXT FIVE (5) YEARS

February 15, 2017


As you well know, there are many projections relative to economies, stock market, sports teams, entertainment, politics, technology, etc.   People the world over have given their projections for what might happen in 2017.  The world of computing technology is absolutely no different.  Certain information for this post is taken from the publication “COMPUTER.org/computer” web site.  These guys are pretty good at projections and have been correct multiple times over the past two decades.  They take their information from the IEEE.

The IEEE Computer Society is the world’s leading membership organization dedicated to computer science and technology. Serving more than 60,000 members, the IEEE Computer Society is the trusted information, networking, and career-development source for a global community of technology leaders that includes researchers, educators, software engineers, IT professionals, employers, and students.  In addition to conferences and publishing, the IEEE Computer Society is a leader in professional education and training, and has forged development and provider partnerships with major institutions and corporations internationally. These rich, self-selected, and self-paced programs help companies improve the quality of their technical staff and attract top talent while reducing costs.

With these credentials, you might expect them to be on the cutting edge of computer technology and development and be ahead of the curve as far as computer technology projections.  Let’s take a look.  Some of this absolutely blows me away.

human-brain-interface

This effort first started within the medical profession and is continuing as research progresses.  It’s taken time but after more than a decade of engineering work, researchers at Brown University and a Utah company, Blackrock Microsystems, have commercialized a wireless device that can be attached to a person’s skull and transmit via radio thought commands collected from a brain implant. Blackrock says it will seek clearance for the system from the U.S. Food and Drug Administration, so that the mental remote control can be tested in volunteers, possibly as soon as this year.

The device was developed by a consortium, called BrainGate, which is based at Brown and was among the first to place implants in the brains of paralyzed people and show that electrical signals emitted by neurons inside the cortex could be recorded, then used to steer a wheelchair or direct a robotic arm (see “Implanting Hope”).

A major limit to these provocative experiments has been that patients can only use the prosthetic with the help of a crew of laboratory assistants. The brain signals are collected through a cable screwed into a port on their skull, then fed along wires to a bulky rack of signal processors. “Using this in the home setting is inconceivable or impractical when you are tethered to a bunch of electronics,” says Arto Nurmikko, the Brown professor of engineering who led the design and fabrication of the wireless system.

capabilities-hardware-projection

Unless you have been living in a tree house for the last twenty years you know digital security is a huge problem.  IT professionals and companies writing code will definitely continue working on how to make our digital world more secure.  That is a given.

exascale

We can forget Moor’s Law which refers to an observation made by Intel co-founder Gordon Moore in 1965. He noticed that the number of transistors per square inch on integrated circuits had doubled every year since their invention.  Moore’s law predicts that this trend will continue into the foreseeable future. Although the pace has slowed, the number of transistors per square inch has since doubled approximately every 18 months. This is used as the current definition of Moore’s law.  We are well beyond that with processing speed literally progressing at “warp six”.

non-volitile-memory

If you are an old guy like me, you can remember when computer memory costs an arm and a leg.  Take a look at the JPEG below and you get an idea as to how memory costs has decreased over the years.

hard-drive-cost-per-gbyte

As you can see, costs have dropped remarkably over the years.

photonics

texts-for-photonoics

power-conservative-multicores

text-for-power-conservative-multicores

CONCLUSION:

If you combine the above predictions with 1.) Big Data, 2.) Internet of Things (IoT), 3.) Wearable Technology, 4.) Manufacturing 4.0, 5.) Biometrics, and other fast-moving technologies you have a world in which “only the adventurous thrive”.  If you do not like change, I recommend you enroll in a monastery.  You will not survive gracefully without technology on the rampage. Just a thought.

DIALYSIS PUMPS

February 8, 2017


I entered the university shortly after Sir Isaac Newton and Gottfried Leibniz invented calculus. (OK, I’m not quite that old but you do get the picture.) At any rate, I’ve been a mechanical engineer for a lengthy period of time.  If I had to do it all over again, I would choose Biomedical Engineering instead of mechanical engineering.  Biomedical really fascinates me.  The medical “hardware” and software available today is absolutely marvelous.  As with most great technologies, it has been evolutionary instead of revolutionary.    One such evolution has been the development of the dialysis pump to facilitate administrating insulin to patients suffering with diabetes.

On my way to exercise Monday, Wednesday and Friday, I pass three dialysis clinics.  I am amazed that on some days the parking lots are, not only full, but cars are parked on the roads on either side of the buildings. Almost always, I see at least one ambulance parked in front of the clinic having delivered a patient to the facilities.  In Chattanooga proper, there are nine (9) clinics and approximately 3,306 dialysis centers in the United States. These centers employ 127,671 individuals and bring in twenty-two billion dollars ($22B) in revenue.  There is a four-point four percent (4.4%) growth rate on an annual basis. Truly, diabetes has reached epidemic proportions in our country.

Diabetes is not only one of the most common chronic diseases, it is also complex and difficult to treat.  Insulin is often administered between meals to keep blood sugar within target range.  This range is determined by the number of carbohydrates ingested. Four hundred (400) million adults worldwide suffer from diabetes with one and one-half million (1.5) deaths on an annual basis.  It is no wonder that so many scientists, inventors, and pharmaceutical and medical device companies are turning their attention to improving insulin delivery devices.   There are today several delivery options, as follows:

  • Syringes
  • Pens
  • Insulin Injection Aids
  • Inhaled Insulin Devices
  • External Pumps
  • Implantable Pumps

Insulin pumps, especially the newer devices, have several advantages over traditional injection methods.  These advantages make using pumps a preferable treatment option.  In addition to eliminating the need for injections at work, at the gym, in restaurants and other settings, the pumps are highly adjustable thus allowing the patient to make precise changes based on exercise levels and types of food being consumed.

These delivery devices require: 1.) An insulin cartridge, 2.) A battery-operated pump, and 3.) Computer chips that allow the patient to control the dosage.  A detailed list of components is given below.  Most modern devices have a display window or graphical user interface (GUI) and selection keys to facilitate changes and administrating insulin.  A typical pump is shown as follows:

insulin-pump

Generally, insulin pumps consist of a reservoir, a microcontroller with battery, flexible catheter tubing, and a subcutaneous needle. When the first insulin pumps were created in the 1970-80’s, they were quite bulky (think 1980’s cell phone). In contrast, most pumps today are a little smaller than a pager. The controller and reservoir are usually housed together. Patients often will wear the pump on a belt clip or place it in a pocket as shown below. A basic interface lets the patient adjust the rate of insulin or select a pre-set. The insulins used are rapid acting, and the reservoir typically holds 200-300 units of insulin. The catheter is similar to most IV tubing (often smaller in diameter), and connects directly to the needle. Patients insert the needle into their abdominal wall, although the upper arm or thigh can be used. The needle infusion set can be attached via any number of adhesives, but tape can do in a pinch. The needle needs to be re-sited every 2-3 days.

pump-application

As you can see from the above JPEG, the device itself can be clipped onto clothing and worn during the day for continued use.

The pump can help an individual patient more closely mimic the way a healthy pancreas functions. The pump, through a Continuous Subcutaneous Insulin Infusion (CSII), replaces the need for frequent injections by delivering precise doses of rapid-acting insulin 24 hours a day to closely match your body’s needs.  Two definitions should be understood relative to insulin usage.  These are as follows:

  • Basal Rate: A programmed insulin rate made of small amounts of insulin delivered continuously mimics the basal insulin production by the pancreas for normal functions of the body (not including food). The programmed rate is determined by your healthcare professional based on your personal needs. This basal rate delivery can also be customized according to your specific daily needs. For example, it can be suspended or increased / decreased for a definite time frame: this is not possible with basal insulin injections.
  • Bolus Dose: Additional insulin can be delivered “on demand” to match the food you are going to eat or to correct high blood sugar. Insulin pumps have bolus calculators that help you calculate your bolus amount based on settings that are pre-determined by your healthcare professional and again based on your special needs.

A modern insulin pump can accomplish both basal and bolus needs as the situation demands.

The benefits relative to traditional methods are as follows:

  • Easier dosing: calculating insulin requirements can be a complex task with many different aspects to be considered. It is important that the device ensures accurate dosing by taking into account any insulin already in the body, the current glucose levels, carbohydrate intake and personal insulin settings.
  • Greater flexibility:  The pump must be capable of instant adjustment to allow for exercise, during illness or to deliver small boluses to cover meals and snacks. This can easily be done with a touch of a button with the more-modern devices. There should be a temporary basal rate option to proportionally reduce or increase the basal insulin rate, during exercise or illness, for example.
  • More convenience: The device must offer additional convenience of a wirelessly connected blood glucose meter. This meter automatically sends blood glucose values to the pump, allowing more accurate calculations and to deliver insulin boluses discreetly.

These wonderful devices all result from technology and technological advances.  Needs DO generate devices.  I hope you enjoy this post and as always, I welcome your comments.

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