Biomedical Engineering Defined Pt 10

Why the change in infectious diseases? Why did I focus on that one?

What makes it so much better to be alive now in terms of your likelihood to die of an infectious disease than it did in London in 1665? Yes, but what specifically? Drugs like antibiotics, penicillin, erythromycin, again something else you probably all had experience with and you think well that’s not Biomedical Engineering, that’s science, that’s somebody discovering a molecule that kills microorganisms.

That’s true, it is science, but in order for that to go from being a science that works in a laboratory or in one hospital to being penicillin, which could be used all over the world, you’ve got to be able to make it in tremendously large quantities and that’s the work of biomedical engineers, making penicillin in the kinds of quantities that you need so that a dose could be available for everyone in the world if they got infected and to make it not just in abundance but make it cheaply enough that everyone could afford it. So, if you can make 100 tons of the drugs, but it costs $100,000 a gram that might not be a useful drug because nobody could afford to use it.

So, it’s the work of biomedical engineers, really, to take these innovations in science like drugs and make them useful, make them so that everybody can take advantage of it. And you also mentioned vaccines and we’re going to talk a lot in the middle part of the course about vaccines and the engineering of immunity. How do you engineer, what happens in our immune system in order to protect us from diseases? That’s another of an area where biomedical engineers have made tremendous contributions.

So, just to go a little bit further with that point, if you looked at the causes of death of London in 1665, here’s a list that I got from a source that was written at that time, and I don’t even understand what some of these things are, but the ones in green are infectious diseases, they’re infectious causes of disease.

Spotted fever in purples for example, which we call measles, was a significant cause of death as was the plague, which we don’t have any more, thank goodness. But, people died typically of either infectious diseases or they died during childbirth or they might have died at old age which would have been 50 or so at that time.

Biomedical Engineering Defined  Pt 10

Biomedical Engineering Defined Pt 9

Things like electricity, having electricity delivered to your home, so you had to have ways to generate electricity and to carry it from point to point and it was engineers that did that, built bridges and roads and automobiles, so we can get from one place to another relatively quickly because of that, because there are airplanes that were also developed by engineers in that century.

We designed a lot of new materials that could be used to build things that couldn’t have been done otherwise. Things like steel and polymers, or plastic and ceramics and, of course, computers which has progressed remarkably due to the work of engineers in your lifetime, until now you can carry around a cell phone, which would have been unthinkable even 30 years ago. Engineers in the twentieth century have transformed our society.

One of the other things that happened during the twentieth century is that human life expectancy increased dramatically, people started living a lot longer. So, what I plot on this graph here is as a function of time, years, dates, life expectancy as a function of time. What you’ll see here is that about for the period before sort of 1700 or so, human life expectancy was less than 40 years of age, so that means a person that was born in that year could expect to live on average about 40 years. That was the expected life span. And the expected life spans increased dramatically in the last couple of hundred years until now, or people that were born when you were born you can expect to live to be 80 years old, a doubling in life span, fairly dramatic.

So, what’s responsible for that? Why are people living longer than they did just a few hundred years ago? Well, there’s a clue here on the slide. I indicated a couple of points here where if we looked in the 1665 in London, you could ask the question, another way to ask the question why are people living so long is to ask the question, why do people die? In 1665, 93% of the people that died in that year died of infectious diseases. In contrast, if you look at a U.S. city, ten years ago in 1997 for example, then people still died but they didn’t die predominantly from infectious diseases. They died from other things, only four percent died from infectious diseases. So, one of the reasons there is a huge increase in life span is because people aren’t dying of things that they would have in prior years.

Biomedical Engineering Defined  Pt 9

Biomedical Engineering Defined Pt 8

Many of the things I showed you were things that were built from parts, that’s a good description. What makes it different from science? Science can be hands-on, you might be down at the lake picking up algae and studying them or something that would be hands-on. But what’s different, what would make you an engineer? Yeah? You design. Scientists observe and try to describe and engineers try to design.

They take those descriptions and the scientist that is known and they try to design new things, and so if you look at a dictionary, it has words like this that you’re doing designing things or another way to say that is that you’re trying to apply science, you’re looking at applications. We’re trying to take scientific information and make something new. The other thing about it is that you could make lots of things that are new but generally you think of engineers as making things that are not just new but they’re useful, that they do something that needs to be done and they do something that improves life, the quality of life of people.

So, here is a brief and very biased history of engineering. It’s short. Engineering became a discipline in about the middle of the 1800s. Lots of universities started teaching engineering as a discipline including Yale. In 1852, around that time, this might have been the first course that was offered in engineering in the country. It was taught at Yale in civil engineering in 1852 and even Yale students don’t know this. What a long distinguished history of engineering that their own institution has. In fact, the first PhD degree in engineering was awarded to a fellow named J. Willard Gibbs at Yale in 1863 for a thesis he did on how gears work or something, I forgot exactly what the details are, but have you heard of Gibbs? Is it a name that rings a bell? Where did you hear about Gibbs from? Yeah, G, Gibbs free energy, that annoying concept that you had to try to master in chemistry at some point, but Gibbs is really the father of modern physical chemistry and was one of the most famous scientists of the nineteenth century and got the first PhD in engineering here at Yale.

Then from these beginnings, engineers transformed life in the twentieth century. So, a lot of things started in the twentieth century and became common place.

Biomedical Engineering Defined  Pt 8

Biomedical Engineering Defined Pt 7

Because you trust biomedical engineers to have done a good job in designing these things and we’ll talk about how biomaterials are designed and tested and what makes a material, the properties of a material that you could use as a contact lens, what are the properties that it needs to have.

This is an example of an artificial hip. We’ve learned a lot about the mechanics of how humans work as organisms over the last 100 years or so, how we work as a sort of physical objects that have to obey the laws of physics that you know about. We live in a gravitational field and that it affects our day to day life, and if you have hip pain or a hip that’s diseased in some way, and you can’t stand up against that gravitational field in the same way, that severely limits what you can do in the world.

So, biomedical engineers have been working for many years on how to design replacement parts for joints like the hip. The artificial hip is the most well developed of those. We’ll talk about this in some detail. You can imagine that there are many requirements that a device like this has to meet in order for it to be a good artificial hip and we’ll talk about those and how the design of these has changed over the years and what we can expect in the future.

Lastly, up here, is a picture of a much smaller device. This is actually an artificial heart valve that is made of plastics and metal and can replace the valve inside your heart. Valvular disease is not uncommon in the world. We’ll talk about that a little bit. We’ll talk about how your normal valves function inside your heart and how your heart couldn’t work in the way that it did if it didn’t have valves that were doing a very complex operation many, many times a day. And then we’ll talk about how you can build something to replace a complicated small part in the body like that.

 

Well, let’s take a step back for a minute, that’s one way of looking at Biomedical Engineering by looking at sort of the things that you now about that have been the result of the work of biomedical engineers and talk more generally. But, what is engineering? What do engineers do? What makes engineering different than other fields of study? What makes it unique so that we have a school of engineering at Yale that’s separate from science and the humanities? Any thoughts? Yeah? It’s much more hands-on. You’re actually in there doing things.

Biomedical Engineering Defined  Pt 7

Biomedical Engineering Defined Pt 6

For example, you all know that the only treatment for some diseases is to get an organ transplant: a kidney transplant or a liver transplant is the only life extending intervention that can be done for some kinds of diseases.

Transplants require donors, and the donor organ is usually not at the same physical location that the recipient is, and so jets like this one have become very important in connecting donors to recipients. A team of surgeons is working to harvest an organ at one site while another team of surgeons is working to prepare the recipient at another site, and the organ is flown there.

Now, why does that happen? Because you have to get the organ from one place to another fast, right? The organ has to get from one place to another very rapidly and this is the fastest way to do it. Well, what if we could develop ways using engineering techniques to extend the life of an organ, so it didn’t have to get it where it went so quickly? Then that would open up lots of more possibilities for organ transplantation than are known now. What if we could figure out ways to avoid organ transplantation entirely? What if we could just take a few cells from that donor organ, ship them to the site, grow a new organ at the site and then implant it there? These are examples of Biomedical Engineering of the future that expand on what we currently use, which involves to no small extent, technology like this.

I would guess that probably 30% to 50% of you do this every day. You put a piece of plastic, a synthetic piece of plastic into your eye to improve your vision. Contact lens technology has changed dramatically from the time that I was born to the time that you were born, and the contact lenses you use today are much different than the ones that would have been used 30 years ago. This is Biomedical Engineering as well. Engineers who are developing new materials, materials that can be, if you think about it, there’s not very many things that you would want to put in your eye and that you would feel comfortable putting into your eye, so this is a very safe, a very inert material. What gives it those properties? What makes it so safe that it can be put in one of the most sensitive places in your body, in contact with your eyes? Why do you have confidence putting it in contact with one of the most important organs of your body?

Biomedical Engineering Defined  Pt 6

Role of an Expert in Addiction Medicine

Michael Jackson’s death was a shock to the entire world. What was more shocking was the cause of his death. Many believed he died to cardiac arrest, but when the truth was revealed in the court no one was able to believe it. The reason for his death was his addiction to a powerful pain medicine. He got addicted to this drug because of his inability to sleep in the night. The medicine helped him sleep. The over dose of this medicine caused his death. All these were the findings of an addiction medicine expert witness who was hired by the doctor who is believed to have given Jackson that drug.

Addiction can be fatal. The young generation considers drinking alcohol a status symbol. There is nothing wrong in that provided the drinking is done occasionally and used to relax the mind. Alcohol relaxes us to an extent that it makes us talk more than we want and this also helps us in socializing. However, this can turn into a permanent addiction which can be dangerous. It is easy to get addicted to something, but it is a mountainous task to come out of that addiction. To get their problem fixed people turn to medication, this help them live without consuming alcohol. Medication can promise numerous things, but it is not always necessary they fulfil their promise every time. The medicine can even have a negative effect on you and can cause harm.

The expert witness comes in handy in such situations. They are experienced people generally expert in pharmacology. They guide the individual on whether they have a rightful claim in case litigation is filed. Their findings are based on the severity of the harm caused by the medication. If the individual has a rightful claim, expert witnesses provide testimony in the court. Their testimony is extremely important for any claim.

Addiction medicine expert witnesses are difficult to find. What is most importance is finding a qualified expert based on addiction. Addiction can be of internet, mobile phones, alcohols, drug, pornography, sex, etc., for these different types of addictions different expert witnesses are available.

For those who are under any sort of medication for addiction and have been harmed or injured by the chemical reaction of these medicines, should consult an addiction medicine expert witness. Thinking such accidents as coincidence is wrong. In such a case the individual has a rightful claim and without fear should approach the court.

Role of an Expert in Addiction Medicine

Emergency Rooms and Expert Witnesses

Emergency room expert post by Sam C.

If you end up in the emergency room, you will be expecting the best possible help for whatever has happened to you. The chances are that you will be in a lot of pain and will be hoping for treatment which will not only ease the pain, but will also help you begin your recovery back to full health. The vast majority of the time, the medicines given and the treatment provided will be beneficial and is going to only improve the situation.

However, there may be rare occasions when errors are made in the emergency room and something goes horribly wrong. For example, a doctor could misdiagnose the problem that somebody comes into the emergency room with, hence providing the wrong treatment for them. They may be given an antiviral drug when they actually needed an antibacterial drug, or they may be given a drug that they are allergic to. Under these circumstances, the likelihood is that the problem will at best stay the same, but could also worsen the problem significantly.

This is where an emergency room expert witness is the key to ensure that the best advice can be provided. They know all of the procedures that should have been taken in the emergency room to make sure that the medicines provided were the correct type and that everything was done correctly with respect to checking the medical history of the patient. For example, if there was an allergy issue, if this was known about then the patient should not have received this treatment, and something different should have been done. An emergency room expert witness will be able to determine whether the correct procedures were taken in order to make the right decision in defending the case.

These expert witnesses are leading experts in the field of medicine. They have the necessary qualifications to not only know the procedures that should have been taken, but also what medicines should have been used in place of the ones actually used. It is therefore important, if you have suffered from what you feel to be negligence from the doctor in the emergency room, to make a referral with a consultant before launching a claim in the courts. The expert witness will provide the best advice possible as well as litigation support, and will also testify in court, as they have an authority that could convince the jury to back you and your claim.

Emergency Rooms and Expert Witnesses

Gastroenterology Expert Witnesses!!

Gastroenterology expert post by Sam C.

As with any other internal disease, the main worry is that it will worsen and develop problems that need some surgery in order to make a full recovery. The problem with intestinal diseases is that they can quickly spread from being a minor issue in a small area, to become a serious problem covering a large surface of the inner body, potentially leading to appendicitis, ulcers or even cancers.

The most important thing to do is to identify any problems early on and attempt to quickly fix the issue before any serious or permanent damage is done. It is equally important to correctly identify the issue, and to ensure that the correct treatment is used so that the damage caused is minimal.

Although doctors are often specialised in certain areas of medicine, even when a patient is admitted to them with a problem in which they are specialised, there is always the chance that a mistake is made, either in the diagnosis or in the treatment. This can either result in the original problem not being sorted, in which case the discomfort still exists for the patient and could get worse, or further problems can be caused due to surgery and drugs used when they weren’t needed. If this is the situation, you may be entitled to receive compensation for your injuries and for the malpractice or negligence of the surgeon. However, if you are intending to make a claim for compensation, it is vital to make a referral with a gastroenterology expert witness, as their consultants can provide the best advice for your individual situation.

The expert witnesses are leading experts in gastroenterology, and they are certified doctors with all the qualifications needed that give them the expert knowledge to base a judgement on whether you may have a case or not. They are specialists and will know all the procedures that the doctors should have gone through before and during the treatment in order to correctly diagnose and treat the problem. This means that they have a good authority in the courts to defend a case in favour of either the defence or the prosecution, and therefore have an important role to play in convincing the jury in favour of your case. These expert witnesses will provide litigation support and testimony when your claim makes it into the courtroom, and may prove pivotal in winning you the case.

Gastroenterology Expert Witnesses!!

Occupational and Industrial Medicine Expert Witnesses

occupational and industrial medicine expert witness post by Sam C.

The human body has a number of defence mechanisms that can help to stave off viruses and bacteria. We can get illnesses from all sorts of places, including our place of work. Although you may not feel it initially (the body often seems to make you able to function perfectly normally whilst you’re working), when you get home you may finally succumb and feel the symptoms.

This can be very frustrating and can leave you unable to work for an extended period of time. Because of this, and the disruption that it may cause you, people will take medication that will hopefully provide your immune system with a boost and will get you back working in no time.

However, what if the medication that is given to you causes your condition to become worse? The occupational and industrial medicine pharmacologists have a duty of care to provide the best medicines that they can and to test them thoroughly to ensure that the risk of side effects is minimal. If they were to create a medicine that caused further harm to the patient, it is very possible that there has been some misconduct or negligence in the testing process. Of course, not all side effects can be compensated for; there are usually warnings on the medication that warn you of the potential complications that may arise out of taking it, so you will probably need something exceptional to happen to you. If these effects cause life changing problems for you, you may find that they are entitled to claim compensation.

Occupational and industrial medicine expert witnesses will help to provide the evidence required to say whether the pharmacologist can be held liable for the injuries that you have suffered. They have years of expertise working with medicines that are put to good use in saying whether the tests conducted by the pharmacologist were appropriate, if they have conducted rigorous tests or if there are any other errors during the manufacturing process. If you are trying to launch a claim against a negligent pharmacologist, you will require somebody who is a certified specialist in the field of medicine to help defend your claim.

Not all problems caused by medicines can be blamed on the pharmacologist. Sometimes, any further illness caused may be due to a side-effect or allergic reaction that was unforeseen by everybody. This is where the occupational and industrial medicine expert witness would assist; they will be able to determine whether the doctor took the necessary precautions against any further problems, and if not, compensation may be claimed. Make sure you get the litigation support you need to win your case.

Occupational and Industrial Medicine Expert Witnesses

Cardiothoracic Surgery and Court Cases

post by Sam C.

Cardiothoracic surgery is a potentially life threatening operation, so therefore the patient must feel confident that the surgeons are adequately trained and that they will perform the surgery in the safest and most successful way.

Since cardiothoracic surgery can involve open heart and open lung operations, they clearly come with a risk of quite damaging effects; the most obvious and immediate being a fatality for the patient, but also longer term discomfort or further damage to the vital organs, which could leave the patient in a lot of pain, or so physically disabled that they are no longer able to work. Without compensation, these unfortunate patients would find their regular lifestyle very difficult to maintain.

Having said this, these problems caused after surgery may not be due to the failure of the surgeon to successfully operate on the patient. Cardiothoracic surgery is the surgical treatment of diseases affecting vital organs. Though this does mean operating on organs such as the heart and lungs, it may not necessarily be the surgeons fault if the operation does not completely eradicate all discomfort of the patient. For example, it may be that the disease has already caused too much of an adverse effect on an organ that it is simply untreatable. Though the patient may feel let down by the efforts of the doctors, it may not be their fault if there is no way of treating the disease, in fact they will have done everything in their power to limit the effects and stop the spreading.

However, sometimes the surgeon is at fault and under these circumstances a cardiothoracic surgery expert witness is required to successfully acquire the compensation that the patient deserves. Such an expert will know all the precautions and procedures that the surgeons should have taken before and during surgery, and they can determine whether the injury was preventable, and whether a claim should be made or not.

It is important that the patient is aware of the situation before making a claim for compensation, so the cardiothoracic surgery expert witness is there to determine whether the injury was caused due to negligence of the surgeon and whether there is a case to be won. The expert is needed to provide substantial evidence for the courts to decide that there is a case in favour of compensation, and for this reason they are very important in aiding the future of those suffering from injuries that were not their own fault.

Cardiothoracic Surgery and Court Cases