Research Programs

A.  Research Domains:

 

1. Biomedical Engineering (BME) 

My Biomedical Engineering (BME) and Healthsciences research has been oriented to provide insights into physiological mechanisms, to develop medical procedures and devices, and carry out pre-surgical analyses to obtain optimal outcomes in my research.   

As a pioneer in this field (from 1960s), I have developed research in Physiological Engineering, Orthopedic mechanics, Pulmonary engineering, Cardiovascular engineering, renal engineering and Endocrine engineering. My latest book Applied Biomedical Engineering Mechanics (CRC Pros, Taylor & Francis) covers cardiological engineering, pulmonary engineering, diabetic engineering, orthopedic biomechanics and sports engineering. The contents of this book have stemmed from my lecture notes and research, and are original. This research has application in both basic areas of physiology and in applied areas of medicine. 

Our work in Cardiological Engineering has been pace-setting. In Cardiac Engineering, we have analyzed and quantified the entire medical and surgical process undergone by a patient from having angina pains to coronary bypass surgery. In the heart (left-ventricle), we pioneered methods for non-invasively detecting diseased heart valves. To replace the diseased valve, we developed optimal prosthetic leaflet heart valve designs. Diseased valves enhance the left-ventricular (LV) chamber’ wall stress and can cause O2 supply-demand mismatch, resulting in the myocardial infarcts; for this purpose, we developed methods to depict normal and diseased myocardial segments.

For the Left Ventricle, we have analyzed LV passive wall stress during the LV filling phase, and determined the myocardial wall elasticity. During isovolumic contraction and ejection phases, we have determined the active wall stress, the orientation and contractile stresses of the myocardial fibers, and the contractile torque generated within the LV. The orientation of the myocardial fibers can serve as a cardiac contractile index, as myocardial infarcts can lower the fiber angle and disorient the contraction process.

Then, in order to quantify impaired LV states, we pioneered the computation and depiction of blood-flow velocities and pressure-differentials inside the LV, before and following the administration of myocardial perfusion agents, so as to develop candidacy for bypass surgery. Finally, to complete the treatment, we have been analyzing the flow-velocity patterns and the vessel wall stresses at both the proximal and distal anastomoses of the coronary graft for designing proximal and distal connectors at the anastomotic sites.

In Cardiovascular Engineering, we have developed the means of non-invasive determination of (i) aortic pressure along with arterial stiffness (and arteriosclerosis) and peripheral resistance, as well as, (ii) LV pressure (P) during the ejection phase; therefrom, we can non-invasively determine LV contractility as (dP/dt)max . Additionally, we have developed another non-invasively determinable non-dimensional contractility index, in term of rate-of-generation of LV myocardial stress (σ* normalized with respect to LV pressure), as (dσ*/dt)max.  We have in fact developed the biomedical engineering characterization of heart failure and its response to treatment. This may be deemed to constitute a landmark in cardiology.

I have also guided research and taught courses in Orthopedics (including Spinal Surgery) for fracture fixation, scoliosis-correction and discectomy at the International college of Surgeons. In Orthopedic medicine and surgery, I have (i) worked on back-pain prevention and treatment, (ii) pioneered the concept of presurgical analysis for optimizing the scoliotic spinal surgical corrective procedure to get the best outcomes, and (iii)carried out the design-analysis of an anterior spinal fracture-fixator that has been successfully employed to make paraplegic patients ambulatory.  

2.  Medical and Health Sciences: Anatomy &Physiology, Medicine & Surgery:


I have researched in and taught Physiological Engineering (analyses of physiological systems with applications in medical assessment) and Anatomical Engineering (modeling of  anatomical structures and organ systems).  My work in this field is pioneering and totally original.


In Anatomy, I have depicted the optimal design of anatomical structures, such as (i) the spinal vertebral-body as a high-strength and light-weight structure, (ii) the spinal disc design enabling it to bear increasing loading with contained deformations, and (iii) of arterial branchings designed to maximize pulse wave transmission and minimize reflections.  

One of my pioneering efforts in Physiological Medicine has been in the formulation of non-dimensional physiological indices (NDPIs) of physiological systems (PSTs). A typical NDPI of a physiological system (PST) is made up of a number of (necessary & sufficient) parameters (adroitly formulated to make the index non-dimensional), based on the engineering modeling of the PST. The advantage of NDPIs is that one can clinically assess the physiological system based on only one integrated index or number.  

Upon simulating the physiological system (PST) model to clinical data, and evaluating the parameters and hence the NDPI, we can determine the NDPI ranges for normal and disordered PSTs. This novel concept has been applied to formulate NDPIs for cardiac contractility, lung ventilatory performance, glucose-insulin dynamics implicit in glucose tolerance testing, vascular flow for diagnosing arteriosclerosis and atherosclerosis, and cardiac fitness detection.

In Pulmonary Medicine, we have been able to show how to:

  1. noninvasively determine lung compliance and resistance-to-flow parameters from lung ventilation volume data;
  2. formulate a lung ventilation index composed of lung compliance and flow resistance parameters, and apply it to detect lung diseases;.
  3. employ the lung ventilation index to indicate improvement in COPD lung status, and decide  on timely weaning of COPD patients from mechanical ventilation.  


In the field of Glucose-Insulin Regulatory dynamics for Diabetes detection, we have:

  1. developed the glucose-insulin control system model;
  1. shown how we can analyze the Oral Glucose Tolerance Test (OGTT) data, by modeling it mathematically in the form of a second-order differential equation, and (i) employ the solutions of this equation to simulate the OGTT data, and (ii) determine the model parameters;
  2. combined the OGTT bioengineering model’s parameters into a composite nondimensional diabetic index to reliably diagnose diabetic patients, and also detect border-line diabetic patients.        


In Orthopedics and Spinal Surgery, I have guided research and taught courses in fracture fixation, scoliosis-correction and discectomy at the International college of Surgeons. In Orthopaedic medicine and surgery, I have (i) worked on back-pain prevention and treatment, (ii) pioneered the concept of presurgical analysis for optimizing the scoliotic spinal surgical corrective procedure to get the best outcomes, and (iii) carried out the design-analysis of an anterior spinal fracture-fixator that has been successfully employed to make paraplegic patients ambulatory.  We have also design-analyzed and published works on (i) a helical plate for fixation of helical fractures, and (ii) customized hip prosthesis.


3. Fitness & Sports Science

I have directed research in this field, in (for instance) (i) non-dimensional fitness index in terms of parameters representing heart-rate, oxygen consumption and breathing-rate response to power expended, while exercising on the treadmill, (ii) energy-efficient modality of jogging and long-distance running, and (iii) analyses,  simulation and techniques for  soccer corner kicks, cricket batting and bowling, and tennis serves.  


4. Healthcare Engineering & Management (HCEM)

This is a new field, that I have developed, to address the needs of hospital economic and management science, based on development of patient-health indices, performance indices of hospital departments, and cost-effective indices for hospital operation. By maximizing the cost-effective index for the hospital operation (under constraints of maintaining acceptable values of performance indices of hospital departments), we can determine the optimal resource distribution and budget allocations.

At the healthcare policy enactment level, HCEM deals with the cost-effective econometrics of the optimal modality of healthcare delivery and coverage at primary, secondary and tertiary levels and their interfaces. The HCEM program is designed to provide cost-effective operation of hospitals and primary-to-tertiary healthcare delivery system.


5. Cognitive science, Psychology & Behaviorism

I am developing new realms in this field, dealing with (i) Consciousness and its devolution into unit minds, mind potential (and evolution) and behaviorism (mind response to human interactions and environment), (ii) integrated theory of consciousness, matter and mind, (iii) therapies for mental disorders and techniques for cognitive development, (iv) psycho-somatic  mechanisms and therapies, and (v) Non-volitional EEG biofeedback methods for treating stress and epilepsy.

Two theories are intrinsic to this evolving field: (i) theory of consciousness, mind and behaviorism (TCMB), and (ii) theory of interaction between cakras (or psychic glands), endocrine glands and organ systems (TCEO). The TCMB can provide new insights into psychology and psychiatry, while TCEO can provide the linkage to psycho-somatic disorders and therapy.

6. Community and Regional Economic development

I am developing this relatively new field, to address the means for developing (i) functionally sustainable communities (FSCs), such as rural communities and energy-resource isolated communities, and (ii) self-reliant economic blocs (made up of compatible neighboring FSCs), for providing regional economic stability and advancement of developing countries.

A functionally sustainable community (FSC) is defined to comprise of several cities with a large rural hinterland, together providing economic sustainability to the community. Sustainable development for cities and towns would be concerned with developing adequate standards of living, based on the provision of community services and environmental quality, maintenance of trade linkages with their rural hinterland, and measures of social justice. On the other hand, sustainable development in the rural hinterland would have to deal with the means of generating revenue (by supplying their produces to the cities and other neighboring FSCs), so as to support their community services (such as healthcare, public transport, education, water supply, sanitation, electrical power) and sustain small businesses.

 

In rural areas, there also needs to be professional opportunities and adequate level of education to service industries, so as to avoid migration to cities. The solutions for these urban-rural compounding problems are: (i) determination of appropriate size of FSC(s), such that there is adequate rural hinterland size to cater to the needs of cities and thereby gather revenue for their own sustainability; (ii) adroit distribution of population in the rural areas, comprising of the revenue generating sector (about 40%), community service sector (about 40%), and small business and financial (cooperative banking) sector (about 20%), such that the revenue brought into the rural townships by the revenue-generating sector is adequate to afford community services and sustain the small-business sector; (iii) adequate industrial development and a competent services sector in cities, so as to provide adequate community services and quality-of-life to the city dwellers.  


Now all of this knowhow to design sustainable communities for grassroots economic development will necessarily have to be developed at the University, and make it available for the local and state governments to then apply it to cultivate sustainable communities for the welfare of the people.   In times to come, urban-rural communities will constitute the basis of grass-roots economic development.  This field is developed in my recent book on Socio-Economic Democracy and the World Government: Collective Capitalism, Depovertization, Human Rights and Template for Sustainable Peace, published by World Scientific and Imperial College Press.


7. Socio-Economic Democracy and World Parliament

This research program is addressing the needs of a new people-centered and people-empowering socio-economic system and political governance. This program provides an enlightened socio-economic-political environment, based on (i) Collective Capitalism (CCP) of cooperatively managed institutions and enterprises, and (ii) a Civilian Democracy (CDM) sans political parties, whereby the most qualified representatives of all the functional sectors of the community get elected to the local legislature. It also specifies a new economic-political structure in the form of autonomous functionally-sustainable communities (FSCs), within regional economic zones (REZs) and self-reliant regional unions (SRUs, such as the EU). This system of FSCs, REZs and SRUs will come under the aegis of (and collectively represented by) a democratically structured World Parliament, over-seeing the development of a comprehensive charter of human rights and social justice for all the people of the world. The neo-humanistic integrated system of CCP and CDM, to be implemented within FSCs, will provide grass-roots socio-economic-political empowerment, contrary to the system of centralized economic and political governance.

 

Herein, we are developing (i) a holistic approach to a sustainable living environment promoting collective welfare, and (ii) a multi-stage road-map towards a world government system for unification of all the communities of the world into one global cooperative. The combined system of socio-economic democracy (involving knowledge and conscientious governance executives elected by and directly representing the various functional sectors of FSCs) and world parliament will help transform the current undignified north-south socioeconomic order into a democratic and equitable globalization order, for collective social security towards achieving sustainable local and global peace.

B.Research Program in: Biomedical Engineering in Functional Anatomy & Physiology, Medical Assessment, Surgical Guidelines & Cost-effective hospital operation

1.  Scope

Our research involves comprehensive biomedical engineering formulations in medical and clinical sciences as well as in  hospital operation. Our involvement in medical sciences is in functional anatomy and applied physiology, to analyse the functional roles of anatomical structures (e.g., in demonstrating the functional efficacy of the spinal vertebral-body and disc)and physiological systems (e.g., the mechanism by which the left ventricular chamber pressure increases during isovolumic contraction).

For bioengineering in medical assessment (in clinical sciences), we have defined a novel concept of physiological systems analysis in terms of non-dimensional physiologicalindices (NDPIs), for quantifying patient health and disease status as well as patient improvement. We have developed NDPIs for several physiological phenomena and systems, and indicated as to how they can be employed diagnostically. Herein, we are presenting NDPIs for (i) Diabetes characterization, (ii) Left-ventricular contractility and (iii) Lung ventilatory function, as three examples of NDPI characterization of physiological systems.

Our work extends to development of novel medical techniques, systems and devices, such as for example: (i)formula for diagnosing heart failure and prognosis of survival for heart-failure patients, (ii) presurgical analysis and technique of coronary bypass grafting to maximize graft patency, (iii) technique for treating a herniated ruptured spinal disc, (iv) index for weaning of chronic obstructive pulmonary disease (COPD) patients from mechanical ventilation, and (v) EEG Biofeedback system for treating neurological diseases (such as epilepsy) and behavioral disorders.

The research projects presented here constitute only a small sample of projects under this research theme. The intent here is to demonstrate research on this theme by means of some sample projects.

2.  Non-Dimensional Physiological Numbers (or Indices, NDPIs) in Medical Diagnostics & Interventional Guidelines

2.1: Introduction

The concept of Non-dimensional Physiological Number or Index (NDPN or NDPI) is quite new, and has been pioneered by me. The concept has been adopted from Engineering wherein non-dimensional numbers (made up of several parameters) are employed to characterize regimes (or strata) disturbance phenomena.

In physiological investigation, the use of non-dimensional indices or numbers can provide a generalized approach for integration of a number of parameters (representing isolated but related events) into one nondimensional physiological index (NDPI) to help characterize an abnormal state associated with a particular physiological system. The evaluation of the distribution of the values of such NDPIs in a big patient-population can then enable us to designate normal and disordered ranges of NDPI, with a critical value of NDPI separating these two ranges. In this way, NDPIs can help us to formulate physiological-health indices (PHIs), to facilitate assessment of and alteration in the states of physiological systems.

We have developed NDPIs for several physiological phenomena and systems (and indicated as to how they can be employed diagnostically) for (i) Determining Risk to becoming diabetic, (ii) Left-ventricular contractility index, (iii) Lung ventilatory function and lung disease detection, and (iv) Fitness characterization based on analysis of heart rate data from treadmill test. Finally we have applied these NDPI’s for (i) formulating and assessing the performance indices of hospital units and (ii) determining the resource index for cost-effective operation, contributory to hospital management-science.

The significance of this research is that it will provide (hitherto unavailable) (i) precise designation of normal and disordered states of physiological systems, (ii) evaluation of the performance characteristics of hospital units, and (iii) determination of budget and resource allocations among hospital systems for their cost-effective operation.

The following applications of NDPI(s) are now provided.

  • 2.2: Modeling and Clinical simulation of Oral Glucose Tolerance Test for diagnosis of diabetes by means of a Non-dimensional index (in a primary care setting).
  • 2.3: Cardiac (left-ventricular) Contractility System index, to assess failing heart syndrome (in a Tertiary-care setting).
  • 2.4: Ventillatory Functional Assessment of Mechanically Ventilated COPD Patients Modelling (in an Intensive Care Unit or ICU) by means of a Lung-Ventilatory Index.

To view and print out this entire section on NDPIs and these three applications, please click on the following link, " NDPI and its applications to Diabetes diagnostic index, Cardiac Contractility index, Lung Ventilatory index ."

3.  Some of our Biomedical Engineering developments in Medicine and surgery

            

The following are some of our developments in biomedical engineering in medicine and surgery:

  • Artificial heart valves (US patent #944379 on prosthetic closure element for the Replacement of the mitral and tricurpid valves in the human Heart;
  • Scoliosis correction technique and Spinal fracture fixation devices;
  • Noninvasive system for detecting myocardial infarcts and degenerated heart valves;
  • Cardiac contractility and resistance-to-filling indices;
  • Candidacy for coronary bypass surgery, and design of anastomoses sleeves;
  • Detection of arteriosclerosis and atherosclerosis;
  • Noninvasive determination of arterial pressure and left-ventricular blood pressure.
  • Determination of Lung compliance & resistance-to-ventilation; index for detecting lung diseases;
  • Diabetes detection, based on modeling of glucose response to glucose intake in oral glucose tolerance test;
  • Index for weaning of chronic obstructive pulmonary disease (COPD) patients from mechanical ventilation,
  • EEG Biofeedback system for treating neurological diseases (such as epilepsy) and behavioural disorders,
  • Indices for detecting kidney obstructions from tracer administration.


4.  Analyzing blood flow velocity and pressure profile in the Coronary Graft (in Coronary Bypass Surgery)

Basis and Model: This work has been prompted by the need to investigate the etiology of coronary bypass graft patency. For this purpose, we have developed a three-dimensional computational fluid-dynamics (CFD) model of a coronary artery bypass system (fig 8). The model solves the Navier-Stokes equations for quasi-steady flow of a Newtonian fluid, using a finite volume approach. The data input to the model are the physiological measurements of flow rates and pressures, shown in fig 9.

Analysis: CFDsimulation of the flow in the system (aorta, graft and host coronary artery) is performed at different time instants of a cardiac cycle. We have computed pressure and velocity  distributions at the inlet and outlet of the graft.  In figures 10 & 11, we have shown the velocity vectors at the inlet and outlet of the graft (i) at t = 0.13sec into the ejection phase, when the aortic pressure is maximum and (ii) at t = 0.30sec into the filling phase.

Results: It is seen that during systole (figure 10a), very little flow turns around into the graft, with little perfusion into the host coronary artery in figure 10b. At a mid-diastolic instant, when the aortic valve is closed, figure 11aillustrates the flow velocity pattern at the entrance to the graft, caused by the backflow from the aorta into the proximal aortic region. At this time, we can note (from figure 11b), that the graft perfusion is appreciable.

To view "Figure 8 -10 " click on this link.

 

5: Theory of Cost-Effective Health-Care delivery

We have shown how non-dimensional physiological indices (or NDPIs) can be formulated to characterize physiological system states in terms of non-dimensional numbers, comprising of a number of physiological system parameters. These numbers can be suitably scaled so that in an NDPI range of 0-100, (i) the range of 70-100 represents a normally or healthy functioning system, (ii) the range of 50-70 constitutes impaired system state, warranting admission to hospital; (iii) a value of <50 implies serious condition, for which the patient may have to be placed in an intensive-care unit (ICU), and (iv) a value < 20 or so is associated with critical end-stage.

These NDPIs can be used to generate a patient’s physiological-health index (PHI), which can be applied to generate (i) a physiological health improvement index (PHII), (ii) overall performance index of (PFI) of operation for a health care unit (such as an Intensive Care Unit), (iii) cost effectiveness index (CEI) for operation of a hospital unit, (iv) profit-performance index (PPI) and (v) the resource index (RSI) required for cost-effective operation of a hospital unit.

This analysis can be viewed on this link "PHII"

Application to Hospital Management:

Our hospital econometric management strategy would be to utilize these PPI and CEI indices, such that we can determine the resource index or RSI (Ri) for which we can obtain acceptable values of PFI, CEI, PPI. This can be formulated as a constrained optimization problem to determine the optimal distribution of budget and resources.. A large number of case studies need to be carried out with these new indices.

In the meanwhile, in fig.12 (refer below link), we have schematized the dynamics of PFI, CEI and PPI in response to RSI, in order to demonstrate how we can determine an optimal Resource Index or resource. It would appear that there is an optimally limiting value of RSI (RSIl) beyond which the PFI does not increase appreciably. It also appears that CEI is maximal at this RSIl value. However, the profit could be somewhat sub-maximum at RSIl. Hence, the RSIo at which the PPI is maximum could be regarded to yield the optimal staffing resource.

Now then, let us formulate how a hospital budget can be optimally distributed. Let a Hospital have ‘n’ number of departments and a prescribed budget (or budget index, BGI). We would want to distribute the budget among the departments, such that none of the ‘n’ departments has a PPI below the acceptable value of PPIo and a CEI below the acceptable value of CEIo.

So the Operation Research problem is to be formulated as follows: How to distribute or divide the given Budget (or Budget Index Value) among the units Ui  (i = 1, ….., n), such that PPIi PPIo and CEIi CEIo for all i. This then is the prime task of a Hospital administrator!

" Schematized dynamics of PFI, CEI and PPI as function of RSIa " (refer to the link)

 

C. Proficiency in Engineering Science 


1.  Modeling and analysis of physiological and organ systems’functions


This analysis involves a wide range of engineering disciplines. For instance, the formulation of cardiac pumping contractility indices requires knowledge of image processing to obtain cardiac chamber volumes combined with both solid and fluid mechanics; in-vivo determination of heart valvular property, for detection of valvular calcification, requires knowledge of vibration analysis of plate and shell structures combined with heart-sound spectral analysis.


My proficiency in engineering-science has enabled me to bring to bear appropriate engineering-science disciplines in biomedical engineering research and teaching. It also has been my insightful experience that teaching and research complement each other.


2. Collaborations with Physicians and Surgeons:


In my R&D, I have collaborated with physicians and surgeons very effectively.


Some of our collaborations have been on:

cardiac contractility measures for impaired hearts, detection of ion overload in transfusion-dependent Thalaosaemia-major patients using cardiac contractility indices, detection of ischemic and infarcted myocardial segments from texture analysis of echo-cardiograms;

coronary bypass surgery candidacy and guidelines; spinal fracture-fixation and deformity-correction;

EEG bio-feedback for treating epilepsy and depression;

noninvasive determination of arterial pressure, arterial stiffness and peripheral resistance; detection of borderline-to-severe diabetes, and resistance to insulin;

characterization of detrusor-sphincter dyssynergia and bladder contractility of paraplegic patients.