A. Research Domains:
1. Biomedical Engineering (BME)
My Biomedical Engineering (BME) and Health sciences 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 Press, 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. Please refer our paper: Validation of a novel noninvasive cardiac index of left ventricular contractility in patients.
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. Details of this work can be obtained from my book: Biomedical Science, Engineering and Technology Chapter 35: Physiological Nondimensional Indices in Medical Assessment: For Quantifying Physiological Systems and Analysing Medical Tests’ Data
In Pulmonary Medicine, we have been able to show how to:
noninvasively determine lung compliance and resistance-to-flow parameters from lung ventilation volume data;
formulate a lung ventilation index composed of lung compliance and flow resistance parameters, and apply it to detect lung diseases;.
employ the lung ventilation index to indicate improvement in COPD lung status, and decide on timely weaning of COPD patients from mechanical ventilation.
Details of these works can be obtained from my book Biomedical Science, Engineering and Technology Chapter 34: Lung Ventilation Modeling for Assessment of Lung Status: Detection of Lung Disease and Indication for Extubation of Mechanically-Ventilated COPD Patients
In the field of Glucose-Insulin Regulatory dynamics for Diabetes detection, we have:
developed the glucose-insulin control system model;
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;
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.
Details of these works can be obtained from my book: Applied Biomedical Engineering Mechanics Chapter 8: Glucose–Insulin Dynamics Modeling
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. For details, please refer our following related publications:
Analysis of the helical plate for bone fracture Fixation,
The Human Lumbar Verterbal Body as an Intrinsic Functionally-optimal Structure
The optimal structural design on the human spinal intervertebral disc .
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. [Applied Biomedical Engineering Mechanics Book Chapter 15: Analysis of Spinning Ball Trajectories of Soccer Kicks and Basketball Throws.]
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.
Cognitive Science is based on the neo-science paradigm that:
(i) Consciousness is the fundamental entity, incorporating the cognitive and operative principles.
(ii) Consciousness expresses itself, through its operative principle, into the five fundamentals (ethereal, aerial, luminous, liquid, and solid) factors, providing the constituents of the physical universe.
(iii) Consciousness emanates microvita, which organize energy into matter to form ectoplasmic (mind) material and physical life structures. In other words, matter is energized into mind material as a phase change.
(iv) From primitive organisms to complex organisms, there is an unfolding of Consciousness due to increasing reflection of Consciousness, with a corresponding increase in physic dilation of the mind and concomitant increase in complexity of the nervous and anatomical structures.
(v) Increasing psychic dilation of the mind, by meditation on Consciousness, leads to intellectual and eventually to parapsychic and intuitional development.
(vi) The psychic dilation of the unit mind eventually culminates in its achieving mental liberation (from its psychic propensities), and merger into Consciousness.
For more information on this topic, please refer to our papers on:
Theory of Consciousness and Cognition.
Physiological Characteristics of the Meditative State.
Closed-Loop EEG Feedback System and its Clinical Application in Treating Neurological Disorders.
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 know how 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. All this is described in detail in my textbook Socio-Economic Democracy and the World Government, by Dhanjoo N. Ghista, World Scientific, 2004.
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
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.
In my book Biomedical Science, Engineering and Technology, Chapter 1: Biomedical Engineering Professional Trail from Anatomy and Physiology to Medicine and Into Hospital Administration: Towards Higher-Order of Translational Medicine and Patient Care
covers the following topics: 1. Anatomy: Spine analysed as an intrinsically optimal structure. 2. Physiology: Mechanism of left ventricle twisting and pressure increase during isovolumic contraction (due to the contraction of the myocardial fibres). 3. Clinical evaluation of Physiological systems in terms of non-dimensional physiological Indices. 4. Medical test: Cardiac fitness index based on treadmill HR variation. 5. Medical physiology: A non-dimensional diabetes index with respect to Oral-Glucose-Tolerance testing. 6. Cardiology: LV contractility index based on normalized wall-stress. 7. Diagnostics: LV contractility index based on LV shape-factor. 8. ICU Evaluation: Indicator for lung-status in mechanically ventilated COPD patients (using lung ventilation modelling and assessment). 9. Monitoring: Noninvasive determination of aortic pressure, aortic modulus (stiffness) and peripheral resistance). 10. Coronary Bypass surgery: Candidacy. 11. Theory of hospital administration: Formulation of hospital units’ performance index and cost-effective index.
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
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. Detail information of NDPIs can be obtained from my journal papers: (i) Nondimensional physiological indices for medical assessment, JMMB, Vol 9, No 4, 2009, and (ii) Physiological Systems' Numbers in Medical Diagnosis and Hospital Cost-Effective Operation, JMMB Vol 4, No 4, 2004 [https://drive.google.com/file/d/1-ptwJFP58gMOwGhC8M941KUNfNhLee/view?usp=sharing]
The significance of this NDPI research is that it can 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.
Together, the above-mentioned book chapter and journal papers cover all these NDPIs as well as
(ii) 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).
(ii) Cardiac (left-ventricular) Contractility System index, to assess failing heart syndrome (in a Tertiary-care setting).
(iii) Ventilatory Functional Assessment of Mechanically Ventilated COPD Patients Modelling (in an Intensive Care Unit or ICU) by means of a Lung-Ventilatory Index.
3. Some of our Biomedical Engineering developments in Medicine and surgery
In summary, 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. Coronary Artery Bypass Graft (CABG) Surgery analysis to optimize its patency Basis and Model:
This work has been prompted by the need to investigate the etiology of coronary artery bypass graft (CABG) patency. At the distal anastomosis of the graft with the occluded coronary artery, the location of the anastomosis and the angle of the graft at the anastomosis has a big effect on the blood flow field and the wall shear stress, which have a big impact on the patency of the graft. For this purpose, we have developed a three-dimensional computational fluid-dynamics (CFD) model of a coronary artery bypass system. 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.
The flow field and the wall shear stress are calculated throughout the cycle. We have shown (i) how the blocked coronary artery is being perfused in systole and diastole, (ii) the flow patterns at the two anastomotic junctions, proximal and distal anastomotic sites, and (iii) the shear stress distributions and their associations with arterial disease. Conclusion: The computed results have revealed that (i) maximum perfusion of the occluded artery occurs during mid-diastole, and (ii) the maximum wall shear-stress variation is observed around the distal anastomotic region.
For implementing these results, it is best to perform patient-specific presurgical coronary bypass system analysis, to determine the best structure of distal anastomosis.
1. Computational model of blood flow in the aorto-coronary bypass graft”, by Meena Sankaranarayanan, Leok Poh Chua, Dhanjoo N Ghista and Yong Seng Tan, in BioMedical Engineering Online 2005, 4:14.
2. Flow studies in three dimensional aorto-right coronary bypass graft system”, by Meena Sankaranarayanan, Leok Poh Chua, Dhanjoo N Ghista and Yong Seng Tan, in Journal of Medical Engineering & Technology, 2006, 30(5): 269-282.
3. Coronary Artery Bypass Grafting Anastomoses’ Hemodynamics and Designs: A Biomedical Engineering Review, by Dhanjoo N Ghista and Foad Kabinejadian, BioMedical Engineering Online, 2013.
For more information, please refer my book chapters:
(i) Augmented Myocardial Perfusion by Coronary Bypass Surgical Procedure, by Dhanjoo N. Ghista et al, Chapter 11, Cardiac Perfusion and Pumping Engineering, World Scientific, 2007 [https://drive.google.com/file/d/16FaVW362iZqnT89txPpZuvL8W2lfEyXw/view?usp=sharing]
(ii) Chapter 15 Coronary Blood Flow Analysis and Coronary Bypass Graft Design
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.
In a hospital, these NDPIs can be used to generate a patient’s physiological-health index (PHI), which can be applied to generate (i) patient’s 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.
The Performance-index (PFI) for a hospital unit (such as an ICU) is given by:
ICU Performance Index (PFI) = (sum of PHIIs of the patients) / (number of patients treated during a specific time period) (1)
The Cost-effectiveness index (CEI) for operation of a hospital unit is given by:
CEI = Performance Index (PFI) / Resource Index (RSI, in terms of salary units) (2)
Now based on Equations (1) and (2), it can be noted that PFI increases with more resources RSI, and CEI decreases with more RSI. So, we need to find an optimal value of RSI (Ro) for which both PFI and CEI are acceptable, or for which PFI = CEI.
Application to Hospital Management, formulating the hospital budget:
We then employ Operations Research methodology to distribute the budget among the hospital departments, such that all the Departments can operate at acceptable values of their performance indices (PFIs) and Cost-effective indices (CEIs). Let us say that a hospital has “n” number of departments and a prescribed budget. The Cost-effective Hospital Operation involves how to optimally distribute the budget among the departments, such that each of the “n” departments has greater than minimal acceptable values of PFIa and CEIa, or such that PFIi = CEIi. So the Operational Research problem is to be formulated as follows: How to distribute or divide the given Budget (or Budget Index Value) among the Hospital departments RSIi (i = 1, . . . . . . . . . . , n) ,such that (i) PFIi ≥ PFIa and CEIi ≥ CEIa, for all i, or (ii) better still PFIi = CEIi, for all i.
This then is the prime task of a Hospital administrator. For more information on this topic, please refer my journal paper and book chapter:
1. Physiological Systems' Numbers in Medical Diagnosis and Hospital Cost-Effective Operation, JMMB Vol 4, No 4, 2004
2. Chapter 1: Biomedical Engineering Professional Trail from Anatomy and Physiology to Medicine and Into Hospital Administration: Towards Higher-Order of Translational Medicine and Patient Care, Biomedical Science, Engineering and Technology, InTech Publisher, 2012.
C. STEM Model of Medicine
We are developing new formats of Biomedical Engineering and Medicine, in the form of computational disciplines of anatomical engineering, physiological engineering, medical engineering, and surgical engineering. Together, these disciplines can transform both biomedical engineering and medicine into a STEM Model of Medicine or STEM2, which can be incorporated into both education and healthcare delivery.
1. Biomedical Engineering formulation of Anatomy, Physiology, Medicine and Surgery:
Through biomedical engineering science analysis of anatomical structures, physiological and organ systems, medical tests data, and surgical procedures, we have developed new insights in:
(i) Anatomy, in how anatomical structures are intrinsically optimally designed for their functional performance, as for example hyperboloid shape of the vertebral body and ellipsoidal shape of left ventricle.
(ii) Physiology, in quantifying physiological systems and developing indices for their function and dysfunction, leading to precision medical diagnostics, such as cardiac contractility index for risk of heart failure.
(iii) Medicine, by developing biomedical engineering formulation of medical diagnostic and assessment methods and indices, including a new concept of non-dimensional indices in medical assessment, such as diabetic index.
(iv) Surgery, involving customized biomedical engineering analysis of surgical procedures (such as of coronary bypass surgery), and design of prosthetic devices (such as vertebral body cage for fractured vertebral body, to preserve its intrinsic hyperboloid shape).
Together, they can provide a more rigorous and precision formulation of medicine, which can be incorporated into the medical curriculum and then also in clinical care.
2. Medical Education and Research Programs, involving biomedical engineering formulation of medical and surgical systems:
Herein, we are describing some of my Education and Research Programs in (i) Physiology, Medicine, Orthopedics and Surgery, (ii) Sports Biomechanics and Medicine, and (iii) Mind-Body Psychosomatic Medicine.
Cardiovascular Medicine: Left Ventricular Wall Stress and Contractility Index, Vector Cardiogram and ECG Signal Processing, Coronary Blood flow and Myocardial Perfusion, Myocardial Infarct detection and Heart Failure, Intra-Ventricular Blood Flow and Candidacy for bypass surgery, Pulse wave velocity and Detection of Arteriosclerosis, Aortic Pressure Profile and Aortic stiffness determination, Coronary Bypass surgery design for maximal patency, Prosthetic Aortic and Mitral Valve designs.
Pulmonary Medicine: Lung Ventilation modeling for Lung disease detection, Lung Ventilatory Index, Lung Gas Transfer performance analysis, Determination of O2 and CO2 Diffusion coefficients, Non-dimensional Gas-transfer index, Indicators for Extubation of Mechanically ventilated COPD patients.
Diabetic Medicine: Glucose-Insulin Regulatory Control systems, Oral Glucose Tolerance Test modeling and model parameters determination, Non-dimensional indices for glucose and insulin responses, Non-dimensional Diabetic Index for Diabetes detection.
Renal Medicine: Kidney Functional analysis, Countercurrent mechanisms and modelling of urine concentration, Osmolality in the descending and ascending limbs of the Loop of Henle, compartmental model of renal clearance kinetics, Physiological measurement of the Glomerular Filtration Rate (GFR), Relationship between blood creatinine levels and the renal clearance rate, Renal clearance convolution analysis; Renography modelling and determination of normalized urine flow rate index to differentiate between obstructed and normal kidneys.
Orthopedic Biomechanics and Surgery: Osteoporosis Index for osteoporosis detection; Structural analysis of plate-reinforced fractured bone and Optimal design of fixation plate; Osteosynthesis using hemihelical plates for fixation of oblique bone fractures, Finite Element analysis and design of Bone-Plate assemblies and Helical Fixation plate.
Spinal Biomechanics and Surgery: Biomechanical Simulation of Scoliotic Spinal deformity and Correction, Presurgical Finite-element Simulation of Scoliosis Correction, Structural analysis of the Spinal Vertebral body as an intrinsically optimal lightweight and high-strength structure, Fractured Vertebral body fixation techniques and design of a vertebral body cage,
Clinical Biomechanics of Spinal Fixation: Anterior, Posterior Fixations; Structural analysis of Intervertebral Disc as an intrinsically optimal minimally deformed structure under spinal loading, Nucleotomized Disc model analysis and solution for disc herniation.
Sports Biomechanics and Medicine: Optimal Walking Modality based on modeling the leg as a Simple-compound pendulum, Optimal Jogging Mode based on Double-compound model of the lower limb; Analysis of Spinning Ball Trajectories of Soccer kicks and Basketball throws, Analysis of high jump and pole vault, Analysis of tennis serves and cricket bowling, Analysis of Ice Hockey Slap shots and Field Hockey Drag flick; Cardiac Fitness Index based on Treadmill test, Evaluation of Hip Joint based on Differential equation model of the Swinging Leg motion, to determine the hip joint damping and stiffness parameters.
Mind-Body Psychosomatic Medicine, Therapy for Psychiatric Disorders, Regenerative Medicine: Mind-body rejuvenation, by boosting cognitive function, increasing gray matter density in the hippocampus, lowering blood pressure and boosting the immune system, reducing depression and easing stress; Triggering of neurohormonal mechanisms that bring about health benefits, as evidenced by increased parasympathetic and reduced sympathetic nerve activity and increased overall HRV, reducing stress and anxiety; Enhanced release of melatonin, which has anti-inflammatory, immune-stimulating, anti-oxidant and regeneration-enhancing properties; Development of non-volitional EEG Biofeedback System Therapy for treating neurological disorders.
Non-dimensional Physiological Indices in Medical Assessment: New Concept of Non-dimensional Physiological Indices (NDPIs) or Physiological Numbers (PHYNs) for analyzing Physiological Systems and Medical Tests’ Data, Sports Fitness index, Cardiac contractility index, Lung ventilation Index to detect lung disorders, Diabetes diagnosis index from oral-glucose-tolerance test, Arterial stiffness or arteriosclerosis index, Mitral Valve Elasticity Index from heart sound and echocardiography data, Bone osteoporosis index, Hospital Departments’ performance-cost indices, and optimizing budget allocation for maximizing patient care with cost-effective hospital operation.