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New Imaging Shows the Day in the Life of a Virus

A virus: that little organism that makes most of us sick with something we have to wait out. There is often no magic cure and we must often wait out the colds, stomach flu and other varies and sundry ailments. But what if your doctor could identify the specific stand of virus you had, could explain which cells in your body the virus is attacking, why it choose some over others, why it is mutating, and what genetic material it is carrying. All of this knowledge could help scientist develop a vaccine or an anti-viral agent so that so many of us can avoid waiting out things like rotavirus, the flu or for our little guy’s respiratory syncytial virus-RSV.

Biomedical Engineering is changing how we study viruses. By developing a new imaging application engineers, from the University of Georgia Tech and Emory, have taken tetravalent RNA imaging probes (also known as MTRIPS) and direct stochastic optical reconstruction microscopy (dSTORM) to investigate the living cells that are in the RSV virus. RSV is part of the RNA class of viruses that can affect animals, humans, plants, bacteria or fungi. RSV is considered a negative single stranded RSV and includes other virus such as the flu. Most of us have had RSV and our bodies have processed it like having a nasty but common cold. Babies under six months or who were born premature can suffer serious breathing complications from this virus however and are often but in a high risk care situation requiring ventilators and sometimes even oscillators. A biomedical engineering team set out to understand the cell structure of RSV without compromising or effecting how the cell replicates or functions within a host environment.

To do this, engineers take the imaging technology (MTRIPS and dSTORM) and probe an active RSV virus. When investigating they are looking at how the virus enters and makes it past the cell wall and into the cell. Upon entering a cell the imaging team then looks at how the virus duplicates itself. This imaging technology also allows the viewer to see its genetic make-up and how it is transferred to humans. But, RSV is messy and can take on more than one form. Most RNA viruses can carry up to 12 segment number codes. And, RSV can spread more than one genetic strand into a human cell. This causes the viruses’ structure to become chaotic making it hard for scientist to depict. But MTRIPS, promptly adhere to the virus within the cell structure, and uses bright colored chemicals to light up the virus like a Christmas tree. This helps the scientist understand where the virus lands in the cells and how the virus exits the cell and spreads its wealth.

This is big news because the imaging probes have allowed the team to look at how a virus enters a host cell, prepares for the attack and then launches the war. When scientists’ can visualize how a virus can do that, then they can understand what part of the virus they need to wage battle against. And what would strike the fear out of any parent’s heart with a severely premature infant or an immune compromised adult. Biomechanical technology is paving the way to how we view, understand and fight the viruses that can cause severe compromise. Now that is worth seeing.

Autism and Robots: An Intervention

A trash compacting robot named Wall-E teaches another robot (EVE) what love means. Through watching old video clips of “My Fair Lady” he evolves into a robot that expresses fear, concern, empathy and love to others—mechanical or human. EVE is a task oriented machine who only understands rote mission-oriented instructions. Wall-E teaches EVE about what it means to care for others—what it means to build a friendship. Hollywood can dream up scenarios where machines can interact, display human characteristics, feelings and dreams. But in reality, can today’s robots teach others how to socialize, be a friend, and understand emotions?

Robots have come a long way—they’re used to detonate bombs, perform medical surgeries, search for survivors after disasters, and robots are helping children with autism develop the social skills needed to make a friend. When a child is diagnosed with autism, their ability to perform skills that most typical children develop is delayed or just not emerging. Often a rigorous form of therapy is needed to help the child learn, perform and generalize a skill. Emotional maturity and the ability to socialize are impacted for most that function on the autism spectrum. Dr. John Murray with the University of Lincoln, UK has developed a robot named “Erwin” that may be able to help.

Erwin stands for an Emotional Robot with an Intelligent Network. Currently Erwin is being put to work and is part of a large PhD study to determine if relationships can be formed between human and robot. If so, children with autism may benefit from practicing their friend-making skills on a robot like Erwin. According to Mriganka Biswas at the University of Lincoln, all humans have unique characteristics to their personalities—good and bad. When characteristics like these are assigned to a robot it makes them less perfect and more human—thus giving interaction between humans and robots more emotional and less command oriented. For now Erwin, is functioning with five emotional characteristics. It seems like Erwin may be too emotionally simple but when working with autism nothing could be better.

Children with autism often have a hard time processing verbal and non verbal cues simultaneously. Most of us don’t even think about all the technical nuances in communication. But a child with autism may not process the facial cues, tone of voice, physical gestures or make eye contact. Erwin is designed to be friendly and engaging and easy to talk with. In fact studies note that children often interacted with robots just as much as they did with adults. Because Erwin is so simple the child can observe how the social interactions are taking place and can participate in a structured learning environment tailored to their needs. Researchers are hoping to gather enough data to present robots like Erwin in a setting where children can understand, label and discern the robots emotions. Moreover the robot can be a predicable, calm presence where interaction and social development can take place. By using an emotionally enhanced robot children can practice the specific skills they need to work on and over time learn to generalize those skills with human peers.

In the meantime scientists continue to collect data from Erwin as he interacts with typical and non typical children. More and more programs are seeing the potential role robotics will play for children with autism. With more and more diagnosis emerging at alarming rates scientist are scrambling for a cause and a cure. But for now, the best prescription for these children is early intervention. And if a robot can help a child learn to make eye contact say or wave hello and smile who can argue about where it all began. After all, when a parent sees their child perform a skill that was considered lost nothing is too simple, or short of being call a miracle. Let’s just say Erwin may be the miracle in helping children with autism learn to be a little more social… a better friend… a little more loving. Now maybe Hollywood wasn’t that far off the mark when they showed us Wall-E being a friend to EVE.

Medical Devices and Cyber Attacks: The War is On

Cyber attacks are not just waging warfare on our home computers. The medical community is preparing for this brand of terrorism because when it strikes an entire hospital network can be shut down threatening information security, system functionality and device operation. For example, John is receiving chemotherapy for advance stage lung cancer. He attends weekly chemotherapy session where a pump administers the prescribed chemo cocktail. In this particular session John settle into a chair while the pump is connected to his port. At first the pump is administering slowly, and then suddenly it is shooting spikes of the cocktail into his system. The pump is immediately shut down and all tubing is removed from John’s port. On that day 27 pumps were removed from outpatient chemotherapy due to malfunction. Appointments had to be cancelled or scheduled at another facility. The cost to troubleshoot the problem that affected the pump goes into the hundreds of thousands of dollars. Meanwhile, the hospital network is slowing down, information cannot be entered. Patient information is inaccessible. John and the facility he was receiving treatment from are victims of a cyber attack.

Cyber attacks can bring an entire medical center down because most of the attacks are from malware intrusions which are designed to damage computer networks or an peripheral connected to the network. This means that most systems are configurable—able to play host to medical hardware bugs. And when a network becomes an all-encompassing system, it makes the malware’s ability to pass through security codes much easier. Integrating systems seems like an organized and cost-effective way to manage a network but to the cyber attacker it is the easiest kind of network to break. Moreover, devices such as infusion pumps, dialysis, ventilators, radiation equipment and electronic equipment in the operating rooms become vulnerable. There are over 300 forms of medical equipment susceptible to cyber attacks and many of those devices are meant to support life. So what can medical facilities do to prepare themselves for a potential threat? The Federal Drug Administration has communicated several recommendations to help the medical community prepare and respond to this new danger.

First, the FDA is asking device manufactures to secure their product. Make sure that unauthorized entities cannot infect or affect the equipment. In addition, all manufactures should have a cyber security plan in place to ensure their device cannot endanger the network it is supported by. Secondly, ensure only approved personnel are working with the devices and that the medical devices operation is priority—a failsafe application should always be available. And lastly, manufactures should communicate when their equipment has fallen prey to a cyber attack. A recovery plan should be put in place and communication regarding the incident and restoration must be announced to facilities that house their equipment.

When it comes to medical devices manufactures must be just as protective of their product as hospitals are for their patients. There is a partnership that warns, protects and safeguards each other for the betterment of the patient. After all we know that Johns chemo incident could have proven deadly if not for a trusted medical professional who intervened. But look at the patients appointment that were canceled, the cost to repair the equipment, the network time lost and the inability to serve patients. It becomes a snow ball effect—patient care is jeopardized, work comes to a stand still and money is spent instead of made. Medical devices must be protected and watched as the threat of cyber attacks becomes a reality. 

Healthcare Going Wireless: The Bio-Patch

Healthcare and technology are starting to join a very healthy relationship. Most hospitals are equipped with high-tech and often robotic equipment that aide surgery, measure heart function, brain waives and muscle response. And while these important tests are taking place we sit in a hospital or lab with wires, sticky gel and tape tethering us to the big thinking machine that is going to lead doctors in our care. But what if you have all of these things done in the comfort of your home or the golf course? No wires, no gels or tape just a tiny paper thin patch that took all of these reading while you went on with your day.

The Bio-Patch is just that– a paper thin sensor developed by researchers out of the Royal Institute of Technology in Stockholm. Geng Yang, principal developer, helped design the patch to measure electrical bio-output through the skin. The patch can be placed on any body part and can measure things such as brainwaves (EEC), heart activity (ECG), and muscle response from neuron stimulation (EMG). This patch can determine if there is any electrical risk with the heart—a major benefit for heart disease affecting so many across both genders. Measuring the electrical flow of the brain can determine if the individual is suffering from a host of issues ranging from epilepsy, dementia, sleep or nervous system issues. This is a land mark development with the case of seizures. EEC testing in a clinical environment does not always pick up on how and when seizures start. But the patch can note when any type of irregular brain activity is occurring because most seizures occur outside of the hospital. And lastly, muscle response to stimulation can also be monitored outside of the hospital so that doctors can get a real understanding of what is happening in a patient’s with a patient’s natural movement.

The Bio-Patch allows patients to monitor their health from home versus in a hospital setting. Moreover it serves as a comfort when a patient transitions from a hospital setting back to the home environment. The patient can apply the patch to determine if there is concern or if healing is progressing as planned. Moreover, as the elderly population increases more and more will live in unassisted setting. This patch could serve as a tool for determining if help is needed. Patients can receive all of the Bio-Patch results on their Smartphones and have the option to email the information to their heath care provider. The patch is thinner then a bandage is comfortable and for the most part unnoticeable. Bio-patch is easy to apply and remove from skin and when you are all done with the testing the patch can be thrown away. It is a simple, efficient, timeless method of making sure your body is on the right track.

As technology develops and becomes available to consumers, our ability to choose how we are tested for certain medical conditions becomes easier. In other words you can find out if a problem exists before your appointment with the doctor. The long waits, the lengthy testing, the gels, wires and tape become a thing of the past. And a consensus of your condition is reached sooner than later. And that is a comfort we all don’t mind having.

PET Scans Proving Beneficial to Lung Cancer Patients

In our lifetime, many of us will know someone or ourselves, diagnosed with cancer. Out of all the cancers, lung is of the most prevalent. While smoking can increase your risk for developing lung cancer researchers are baffled as to why non smokers are not immune. One thing is for sure—once you have the disease there is no time to loose when determining treatment options. And with Positron Emission Tomography (PET) physicians can understand what types of cells are producing tumors, if the growth is benign or malignant and most importantly if the malignancy is aggressive and fast acting. With PET imaging doctors are able to make smarter and more guided decisions about ongoing cancer treatment for lung cancer patients.

Lungs are one of the most important organs our body houses. It is how we get needed air into our bloodstream and release carbon dioxide. In order to do this the lungs are made of many different types of cells. The epithelial cell is one type of cell that makes mucus that lines and protects the lung walls. Nerve, hormone and structure cells share space and play and important role in supporting lung function. Knowledge of these cells is crucial because cancer can develop in the lungs in two different ways. Non Small Cell cancer develops in the epithelial cell and is considered the most common. Small Cell starts in the nerve or hormone producing cells. Doctors use PET imaging to help them determine which cell the cancer is starting in because Non Small Cell activity has to be treated differently then Small Cell. In addition to determining the cell origin, PET goes beyond showing the cell structure by lighting up areas of activity within the cell or organ. This allows physicians to understand where the cancer is coming from and what areas of the organ are cancerous. This information helps physicians determine best initial treatment options upon diagnosis.

Once the first round of treatment is complete doctors have noticed that follow up PET scans help determine if initial radiation and/or chemotherapy was successful and if further care is necessary. In a study conducted by Mitch Machtay, M.D., at the SeidmanCancerCenter, 250 stage three lung cancer patients were selected from 60 cancer centers within the United States. Patients received one PET scan before treatment and one after. In both scans patients are injected with a radioactive dye. Cancer cells like the sugar (energy) in the dye and most areas that lit up had cells that were processing the sugar at a very high rate. The higher the sugar uptake in the original tumor the more likely the tumor will be labeled as “aggressive” and reoccurring. This knowledge guides physicians in how they continue treatment and prepare patients for managing the disease.

With all the scan options available to lung cancer patients PET scans are providing the most promise in identifying malignancy, cell origination and determining what course of care is necessary after initial cancer treatment. This is the most non-invasive method for guiding physicians in how they plan cancer treatment. PET scans provide more then a shadow or picture—PET scans show cell activity, cancer growth and form. From the non aggressive isolated stage I growth to the reoccurring stage IV mega tumor—PET scans guide physicians on how to stage the medical battle for your lungs.

Technology/Equipment and Communication Errors Impact Surgical Procedures

Your child is getting ready for a tonsillectomy—a fairly routine outpatient procedure. You are confident in the surgeon and know your child is at a qualified facility. But is the surgeon a team player? Is he communicating effectively with the surgical team? Furthermore, beyond the surgeons expertise is all the operative equipment accounted for and functioning? These are all assumptions we make before entering surgery trusting our lives to the medical community that should under all assumptions be communicating with one another, playing on the same team and understanding and accounting for all necessary equipment. But, a few studies are raising eyebrows about how well our operating rooms teams are prepared with surgical equipment/technology and behavioral communication.

Technology and equipment problems are climbing the statistical latter in accounting for 23.5% of surgical malfunctions. In a study published in BMJ Quality and Safety, researchers reviewed published studies regarding operating room mistakes. In addition databases were caroused so that a total of 19,362 scenarios were available for study. From the articles the research team divided the errors into the following scenarios:

  • How the equipment was configured accounted for 4 out of 10 errors
  • Access to equipment/technology was present in 37% of the cases reviewed
  • And 1/3 cases experienced equipment failure

Authors also noted that out of the 16% of patients readmitted to the hospitals half are due to surgical mishaps. With these numbers communication and quality control come to mind. Communication and verification is an important procedure in any surgical protocol. So why is it often the first step missed?

According to an article written in the Deutsches Arzteblatt, Axel Fudickar agrees with the World Health Organization in instituting a surgical checklist. Fudickar purports that the most common mistakes in the operating room are due to bad communication and lack of team work. After all, there is no “I” in team and a surgical team must be on the same page with addressing the needs of the patient. For example, anesthesia needs must be discussed as a team and followed before, during and after surgery. The right equipment, working equipment and a team that understands the technology being used for the surgery is crucial. In fact, since the checklist has been instituted more perioperative mortality rates have decreased by as much as 62%. The World Health Organization check list ensures the surgical team knows the patient’s identity, names and the purpose all personnel in the operating room. Moreover, knowledge of equipment, where it is placed, if it works is key as well.

When you think about it, wouldn’t you want your child’s surgical team crossing their I’s and dotting their T’s? According to Fudickar 90% of physicians would want the check list used before they went under the knife. It just makes good sense with operating room use a quality control protocol- it is so crucial to the patients and if the check list is used as a tool think of what it means for the communication, the team work and the safe outcome.

The Complexities of Modern Ultrasound Equipment

Ultrasound equipment has been in extensive use in the healthcare industry for over half a century. While it’s most commonly associated with obstetric ultrasonography used to visualize fetuses in the womb during pregnancy, it is also used as a diagnostic tool to visualize internal organs, muscles, and tendons. This allows radiologists and sonographers to examine the size, structure, and pathology of these internal structures in real-time with tomographic images.

The last few years have seen a lot of advances in technology, both inside and outside the healthcare industry. These days, ultrasound devices are complex, computerized, and software-driven, a big change from the traditional hardware systems of the old days. These more complex modern ultrasound devices require a more complex understanding of their workings not only for proper operation, but also for repair, maintenance, and security.

One of the major changes in ultrasound technology is how much data it now handles. Older machines were not nearly as customizable as modern ones, and as a result, modern machines handle a massive load of data, including user presets, patient data, networking data, protocol information, and data used for calculations. If this data is lost, it not only takes significant amounts of time to restore, but it can make repairs and upgrades impossible until solutions have been found. A key element to maintaining a modern ultrasound network is keeping up-to-date copies of saved presets and other data.

Because of that same vast amount of data, and because most ultrasound systems are now attached to a clinic network, security becomes an important consideration. Not only does the data need to be protected from possible losses or accidental changes through backups, but it also needs to have a security infrastructure in place that keeps the data safe from external threats. This is part of good information technology and network management, which is important to all medical devices, including ultrasound equipment.

Since modern ultrasound equipment is software-based, technicians also need a working knowledge of the software, and software needs to be available to reload onto the machine as needed. Many vendors provide software backups, but if not, backup copies of an ultrasound unit’s hard drive can be made and stored.

Because modern ultrasound systems incorporate high tech computers, and because they are so complex (and ultimately expensive), careful maintenance, preventative maintenance, and accreditation all become increasingly important. Preventative maintenance should be done at least once a year, and can include things like phantom imaging. The American College of Radiology (ACR), the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL), and the Intersocietal Commission for the Accreditation of Vascular Testing (ICAVL) are all organizations that offer accreditation on ultrasound. Their standards and requirements are good guidelines for any ultrasound program, with the ACR having generally the most rigorous standards.

Medical Device Security

Anyone who has ever worked in the information technology (IT) field in any capacity can tell you that security is an important part of the job, and becoming more important every day. Security and privacy are also of paramount importance in the healthcare and biomed industries. Hence, more and more focus is being placed on security in medical devices, particularly those devices that are connected to a network or stand-alone devices with wireless networking capabilities.

Medical devices have to comply with federal regulations regarding patient safety and privacy, including the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH), which are designed to ensure that all “protected health information” is secure, whether it’s in electronic or paper format. And since most modern medical devices are computerized and connected to networks allowing them access to sensitive patient information, privacy and security become increasingly important. The National Institute of Standards and Technology (NIST) also provides guidelines for controlling access to information technology systems.

More than just patient data is at risk if medical device security is compromised. Studies have demonstrated that implanted heart defibrillators can be hacked from a distance of 50 feet and made to deliver fatal shocks to the patient. Similarly, insulin pumps can also be hacked using fairly simple equipment, with potentially fatal effects for the patient.

These are the kinds of major security risks that have arisen in the last few years, with the advent and increased use of wireless and networked technology, and they’re why security and privacy should be at the forefront of any considerations when dealing with medical devices. Security is a consideration throughout the lifecycle of the device, from the moment it’s built to the moment it’s disposed of. For healthcare and biomedical professionals, security checks can be put in place at every stage of the life cycle, from market analysis through acquisition, inspection, installation, operation, and disposal.

While the security concerns—and many of the solutions—for medical devices are the same as any IT system, medical device security must be approached with greater diligence and caution. Not simply because the risks are higher, but also due to the specific nature of the device. While patches to manage the security of a medical device are a common solution, they must be implemented with care. The vendor of the medical device has to assess and approve every patch or update, to make sure that it doesn’t compromise the original configuration or functionality, as implemented by the manufacturer or vendor. Once the vendor has signed off on the patch, then updates can be installed as on any other IT system. This added layer of vigilance means that a security program, one intended to monitor and update security on a regular, recurring basis, is integral to a smoothly functioning healthcare organization.

The Benefits of Laboratory Automation

Modern laboratories face a bewildering array of challenges, including increased demand for diagnostic testing, reduced budgets, labor shortages, new federal regulations, and quality mandates for health providers. Whether large or small, labs all over the world are feeling the pressure from these challenges, and many labs are relieving some of that pressure by turning to automation.

Automation can not only help labs face challenges, but it can also be a way to help them grow their business in ways that weren’t practical or cost-effective before. By increasing the amount of testing that a lab can process, and by increasing the speed and efficiency of a lab’s current testing load, automation can help grow business while also reducing costs. Automated labs can go after outreach business that brings with it higher profit margins.

Adopting lab automation can have impacts at every level of the testing process: pre-analytical, analytical, and post-analytical. Automated systems can handle dozens of everyday lab processes, taking the burden off skilled technicians and freeing them up for other work. Automated systems can load and unload a centrifuge, decap and recap tubes, load samples into analyzers, and recall samples for add-on tests, along with countless other functions. By automating these routine tasks, technicians can focus on samples that require special preparation or attention.

Automation can also reduce costly errors in testing and production. No matter how well trained, a human technician performing the same task over and over again is bound to make a mistake, or even just introduce slight variations. That’s why they call it “human error.” An automated system can perform the same task repeatedly without any variation. This is especially important in laboratory settings, where very small margins of error exist.

Eliminating mistakes and variations saves money on wasted samples, as well as time spent correcting the error. It also reduces turnaround time, allowing labs to deliver results sooner, and also allowing labs more time to work on more testing. Finally, eliminating mistakes and variations through automation provides a more consistent quality of work. Testing results are more consistent across the board, which is good for everyone.

As more and more labs turn to automation, advances in automation systems continue every day. Since adopting an automated system can be a significant investment, labs are increasingly demanding that their systems be personalized to their needs, as well as customizable and upgradable across a long timeframe. Nobody wants to adopt an automated system, only to have to replace it in a few years. Implementing automation into existing computer networks and information technology systems, as well as the use of software and “middleware,” ensures that automation can run smoothly and efficiently. Customizable, software-based automation systems also allow for tailoring to the specific needs of a lab, and for expansion and upgrades over time.

New Technological Solutions to "Alarm Fatigue"

Though difficult to exactly define or study, “alarm fatigue” is a significant problem in the health care industry. According to the Food and Drug Administration (FDA), there were over 500 alarm-related deaths in the years between 2009 and 2012. So what is “alarm fatigue?”

Patients in serious condition at a hospital are usually placed on some sort of clinical monitoring apparatus. A system that monitors physiological conditions and sets off an alarm to alert clinical staff of abnormalities in a patient’s vital signs. Even people outside the healthcare industry are familiar with them from TV shows and movies, where the steady beep or sudden alarm of the heart monitor have been used to dramatic effect time and again. “Alarm fatigue” happens when there are an excess number of these clinical alarms, which can lead overworked clinical staff to miss or ignore alarms, which can have adverse or even deadly effects.

Part of the reason for “alarm fatigue” is that the majority of alarms are either false alarms, or are clinically insignificant. Studies have found that while there may be as many as 700 or more alarms per patient per day, 80-99% of them are either false or clinically insignificant. Clinically insignificant alarms may include things like a patient’s heart rate falling briefly outside the designated limit before returning to normal and staying there.

In 2003, the Joint Commission listed improving clinical alarm system effectiveness as one of its National Patient Safety Goals, and in 2012 the Emergency Care Research Institute (ECRI) said that “alarm fatigue” was its number one technological hazard.

Most solutions to “alarm fatigue” focus on reducing false or clinically insignificant “nuisance” alarms. Clinics have implemented alarm-management programs, in which alarms are adjusted for more accurate parameters. Some researchers have claimed that these programs can reduce the number of alarms by as much as 43%, but they have their drawbacks. Implementing a proper alarm-management program takes time, as much as 10 months, and lots of care and manpower as technicians and experts adjust the alarms to exacting standards, so that real alarms aren’t missed.

New technology is also helping to combat alarm fatigue. “Smart monitors” are being developed that use “reactive intelligent agent technology” to assess multiple parameters before an alarm is sent. These smart monitors can also add delays, filter signals, and utilize trending devices to ensure the accuracy of an alarm before it is sent. Smart monitors have had a lot of success in reducing the numbers of alarm-related issues, and regulatory bodies are already issuing suggestions and guidelines for integrating smart monitors and related data into clinical monitoring systems.

Another technological solution to “alarm fatigue” that is being developed is “black boxes” that link monitors to personal communication devices like cell phones. At present, these are not treated as medical devices, and so aren’t subject to the same rigor, and should be used only as back-up alarms. However, with the advent of smartphone technology and more and more portable personal computing devices, the trend of an ever more networked alarm system is only likely to continue to increase.