The Medical Device Coordination Framework (MDCF) is an open source middleware package for interop... more The Medical Device Coordination Framework (MDCF) is an open source middleware package for interoperable medical devices, designed to support the emerging Integrated Clinical Environment (ICE) interoperability standard. As in any open system, medical devices connected to the MDCF or other ICE-like network should be authenticated to defend the system against malicious, dangerous, or otherwise unauthorized devices. In this paper, we describe the creation and integration of a pluggable, flexible authentication system into the almost 18,000 lines of MDCF codebase, and evaluate the performance of proof-of-concept device authentication providers. The framework is sufficiently expressive to support arbitrary modules implementing arbitrary authentication protocols using arbitrarily many rounds of communication. In contrast with the expected costs in securing nontrivial systems, often involving major architectural changes and significant degradation of system performance, our solution require...
A major challenge of higher education institutions is to prepare professionals capable of learnin... more A major challenge of higher education institutions is to prepare professionals capable of learning by building effective solutions that are able to integrate different disciplines and knowledge areas. With this in mind, academics and researchers from ESPOL university in Ecuador, have designed laboratory experiments for a digital control class that introduces students to a modular design of embedded feedback controllers using Field Programmable Gate Array (FPGA) technologies. The proposed experiment includes the design of direct discrete time PID controllers, for an existing speed control system with three different sampling times, to test and compare their performance. The obtained controllers are implemented using a prototyping strategy that relies on FPGA development boards. The prototype controller is tested using the experimental plant, and the system performance is contrasted with results from simulations under realistic conditions.
Revista Peruana de Medicina Experimental y Salud Pública, 2012
Objetivos. Evaluar si la taquipnea y las retracciones subcostales son predictoras eficientes para... more Objetivos. Evaluar si la taquipnea y las retracciones subcostales son predictoras eficientes para el diagnóstico de neumonía adquirida en la comunidad (NAC) en niños. Materiales y métodos. Se revisaron las bases de datos: PubMed, LILACS, The African Journal Database y The Cochrane Central Library. Se incluyeron estudios originales que evaluaron el rendimiento diagnóstico de los criterios clínicos de taquipnea o retracciones subcostales, definidos según los criterios de la Organización Mundial de la Salud (OMS) para el diagnóstico de NAC en niños de hasta cinco años de edad con tos y fiebre. Se estimaron las razones de probabilidades (LR), el odds ratio diagnostico (DOR) y sus respectivos intervalos de confianza al 95% (IC95%) para cada prueba clínica evaluada. Resultados. Se encontraron 975 estudios, incluyendo ocho en la revisión. Se enrolaron 4740 pacientes y analizaron 3584 (75%), de los cuales 916 (19%) tuvieron el diagnóstico de NAC. Al combinar los datos, la taquipnea obtuvo una LR positiva de 3,16, (IC95% 2,11-4,73) y una LR negativa de 0,36 (IC95% 0,23-0,57). El DOR fue de 10,63 (IC95% 4,4-25,66, I 2 =93%). Al realizar el análisis para retracciones subcostales se obtuvo un LR positivo de 2,49 (IC95% 1,41-4,37) y un LR negativo de 0,59 (IC95% 0,4-0,87). El DOR fue de 5,32 (IC95% 1,88-15,05, I 2 =89%). Conclusiones. Se puede tomar en cuenta la presencia o ausencia de taquipnea y retracciones subcostales en el diagnóstico de NAC, cabe considerar la incertidumbre relativa en su poder diagnóstico y los LR relativamente modestos. La confianza en estos resultados es baja por la inadecuada calidad de la evidencia en este tema.
Haemoptysis is a common pathology around the world, occurring with more frequency in low-income c... more Haemoptysis is a common pathology around the world, occurring with more frequency in low-income countries. It has different etiologies, many of which have infectious characteristics. Antifibrinolytic agents are commonly used to manage bleeding from different sources, but their usefulness in pulmonology is unclear. To evaluate the effectiveness and safety of antifibrinolytic agents in reducing the volume and duration of haemoptysis in adult and paediatric patients. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) and the Database of Abstracts of Reviews of Effects (DARE) in The Cochrane Library, EMBASE and LILACS for publications that describe randomized controlled trials (RCTs) of antifibrinolytic therapy in patients presenting with haemoptysis. We also performed an independent search in MEDLINE for relevant trials not yet included in CENTRAL or DARE.We conducted electronic and manual searches of relevant national and international journals.We reviewed the reference lists of included studies to locate relevant randomized controlled trials (RCTs). An additional search was carried out to find unpublished RCTs. We included RCTs designed to evaluate the effectiveness and safety of antifibrinolytic agents in reducing haemoptysis in adult and paediatric patients of both genders presenting with haemoptysis of any etiology and severity. The intervention of interest was the administration of antifibrinolytic agents compared with placebo or no treatment. All reviewers independently assessed methodological quality and extracted data tables pre-designed for this review. We found two randomized controlled trials which met the inclusion criteria: Tscheikuna 2002 (via electronic searches) and Ruiz 1994 (via manual searches). We did not exclude any of the relevant studies we found.Tscheikuna 2002, a double-blind RCT performed in Thailand, evaluated the effectiveness of tranexamic acid (TXA, an antifibrinolytic agent) administered orally in 46 hospital in- and outpatients with haemoptysis of various etiologies. Ruiz 1994, a double-blind RCT performed in Peru, evaluated the effectiveness of intravenous TXA in 24 hospitalised patients presenting with haemoptysis secondary to tuberculosis.Pooled together, results demonstrated a significant reduction in bleeding time between patients receiving TXA and patients receiving placebo with a weighted mean difference (WMD) of -19.47 (95% CI -26.90 to -12.03 hours), but with high heterogeneity (I² = 52%). TXA did not affect remission of haemoptysis evaluated at seven days after the start of treatment. Adverse effects caused by the drug's mechanism of action were not reported. There was no significant difference in the incidence of mild side effects between active and placebo groups (OR 3.13, 95% CI 0.80 to 12.24). There is insufficient evidence to judge whether antifibrinolytics should be used to treat haemoptysis from any cause, though limited evidence suggests they may reduce the duration of bleeding.
... [Intervention Protocol] Antifibrinolytic therapy to reduce hemoptysis from any cause Gabriela... more ... [Intervention Protocol] Antifibrinolytic therapy to reduce hemoptysis from any cause Gabriela Prutsky1, Juan Pablo Domecq1, Carlos A Salazar2, Roberto Accinelli3 ... Stroke: sudden, not convulsive event due to cerebral ischemia or intracranial hemorrhage (Adams 1981). ...
Non-pharmacological preventive treatment of sustained ventricular arrhythmias in chagasic disease... more Non-pharmacological preventive treatment of sustained ventricular arrhythmias in chagasic disease is a challenge. Given that the involvement of the autonomic nervous system is one of its determinants, thoracic sympathectomy could be a valuable tool in some selected cases.
Management of complex ventricular arrhythmias due to chagasic myocarditis is challenging. We here... more Management of complex ventricular arrhythmias due to chagasic myocarditis is challenging. We herein present the case of a young male who was presented with incessant well tolerated polymorphic ventricular tachycardia of unknown cause, who was unresponsive to conventional medical management and as a last resort was submitted to a thoracoscopic bilateral sympathectomy, and showed remarkable improvement in his arrhythmia control. Later on his tests returned positive for Chagas' disease and shortly thereafter he suddenly died.
no es un órgano oficial del Departamento Nacional de Planeación. Sus documentos son de carácter p... more no es un órgano oficial del Departamento Nacional de Planeación. Sus documentos son de carácter provisional, de responsabilidad exclusiva de sus autores y sus contenidos no comprometen a la institución.
The Medical Device Coordination Framework (MDCF) is an open source middleware package for interop... more The Medical Device Coordination Framework (MDCF) is an open source middleware package for interoperable medical devices, designed to support the emerging Integrated Clinical Environment (ICE) interoperability standard. As in any open system, medical devices connected to the MDCF or other ICE-like network should be authenticated to defend the system against malicious, dangerous, or otherwise unauthorized devices. In this paper, we describe the creation and integration of a pluggable, flexible authentication system into the almost 18,000 lines of MDCF codebase, and evaluate the performance of proof-of-concept device authentication providers. The framework is sufficiently expressive to support arbitrary modules implementing arbitrary authentication protocols using arbitrarily many rounds of communication. In contrast with the expected costs in securing nontrivial systems, often involving major architectural changes and significant degradation of system performance, our solution require...
A major challenge of higher education institutions is to prepare professionals capable of learnin... more A major challenge of higher education institutions is to prepare professionals capable of learning by building effective solutions that are able to integrate different disciplines and knowledge areas. With this in mind, academics and researchers from ESPOL university in Ecuador, have designed laboratory experiments for a digital control class that introduces students to a modular design of embedded feedback controllers using Field Programmable Gate Array (FPGA) technologies. The proposed experiment includes the design of direct discrete time PID controllers, for an existing speed control system with three different sampling times, to test and compare their performance. The obtained controllers are implemented using a prototyping strategy that relies on FPGA development boards. The prototype controller is tested using the experimental plant, and the system performance is contrasted with results from simulations under realistic conditions.
Revista Peruana de Medicina Experimental y Salud Pública, 2012
Objetivos. Evaluar si la taquipnea y las retracciones subcostales son predictoras eficientes para... more Objetivos. Evaluar si la taquipnea y las retracciones subcostales son predictoras eficientes para el diagnóstico de neumonía adquirida en la comunidad (NAC) en niños. Materiales y métodos. Se revisaron las bases de datos: PubMed, LILACS, The African Journal Database y The Cochrane Central Library. Se incluyeron estudios originales que evaluaron el rendimiento diagnóstico de los criterios clínicos de taquipnea o retracciones subcostales, definidos según los criterios de la Organización Mundial de la Salud (OMS) para el diagnóstico de NAC en niños de hasta cinco años de edad con tos y fiebre. Se estimaron las razones de probabilidades (LR), el odds ratio diagnostico (DOR) y sus respectivos intervalos de confianza al 95% (IC95%) para cada prueba clínica evaluada. Resultados. Se encontraron 975 estudios, incluyendo ocho en la revisión. Se enrolaron 4740 pacientes y analizaron 3584 (75%), de los cuales 916 (19%) tuvieron el diagnóstico de NAC. Al combinar los datos, la taquipnea obtuvo una LR positiva de 3,16, (IC95% 2,11-4,73) y una LR negativa de 0,36 (IC95% 0,23-0,57). El DOR fue de 10,63 (IC95% 4,4-25,66, I 2 =93%). Al realizar el análisis para retracciones subcostales se obtuvo un LR positivo de 2,49 (IC95% 1,41-4,37) y un LR negativo de 0,59 (IC95% 0,4-0,87). El DOR fue de 5,32 (IC95% 1,88-15,05, I 2 =89%). Conclusiones. Se puede tomar en cuenta la presencia o ausencia de taquipnea y retracciones subcostales en el diagnóstico de NAC, cabe considerar la incertidumbre relativa en su poder diagnóstico y los LR relativamente modestos. La confianza en estos resultados es baja por la inadecuada calidad de la evidencia en este tema.
Haemoptysis is a common pathology around the world, occurring with more frequency in low-income c... more Haemoptysis is a common pathology around the world, occurring with more frequency in low-income countries. It has different etiologies, many of which have infectious characteristics. Antifibrinolytic agents are commonly used to manage bleeding from different sources, but their usefulness in pulmonology is unclear. To evaluate the effectiveness and safety of antifibrinolytic agents in reducing the volume and duration of haemoptysis in adult and paediatric patients. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) and the Database of Abstracts of Reviews of Effects (DARE) in The Cochrane Library, EMBASE and LILACS for publications that describe randomized controlled trials (RCTs) of antifibrinolytic therapy in patients presenting with haemoptysis. We also performed an independent search in MEDLINE for relevant trials not yet included in CENTRAL or DARE.We conducted electronic and manual searches of relevant national and international journals.We reviewed the reference lists of included studies to locate relevant randomized controlled trials (RCTs). An additional search was carried out to find unpublished RCTs. We included RCTs designed to evaluate the effectiveness and safety of antifibrinolytic agents in reducing haemoptysis in adult and paediatric patients of both genders presenting with haemoptysis of any etiology and severity. The intervention of interest was the administration of antifibrinolytic agents compared with placebo or no treatment. All reviewers independently assessed methodological quality and extracted data tables pre-designed for this review. We found two randomized controlled trials which met the inclusion criteria: Tscheikuna 2002 (via electronic searches) and Ruiz 1994 (via manual searches). We did not exclude any of the relevant studies we found.Tscheikuna 2002, a double-blind RCT performed in Thailand, evaluated the effectiveness of tranexamic acid (TXA, an antifibrinolytic agent) administered orally in 46 hospital in- and outpatients with haemoptysis of various etiologies. Ruiz 1994, a double-blind RCT performed in Peru, evaluated the effectiveness of intravenous TXA in 24 hospitalised patients presenting with haemoptysis secondary to tuberculosis.Pooled together, results demonstrated a significant reduction in bleeding time between patients receiving TXA and patients receiving placebo with a weighted mean difference (WMD) of -19.47 (95% CI -26.90 to -12.03 hours), but with high heterogeneity (I² = 52%). TXA did not affect remission of haemoptysis evaluated at seven days after the start of treatment. Adverse effects caused by the drug's mechanism of action were not reported. There was no significant difference in the incidence of mild side effects between active and placebo groups (OR 3.13, 95% CI 0.80 to 12.24). There is insufficient evidence to judge whether antifibrinolytics should be used to treat haemoptysis from any cause, though limited evidence suggests they may reduce the duration of bleeding.
... [Intervention Protocol] Antifibrinolytic therapy to reduce hemoptysis from any cause Gabriela... more ... [Intervention Protocol] Antifibrinolytic therapy to reduce hemoptysis from any cause Gabriela Prutsky1, Juan Pablo Domecq1, Carlos A Salazar2, Roberto Accinelli3 ... Stroke: sudden, not convulsive event due to cerebral ischemia or intracranial hemorrhage (Adams 1981). ...
Non-pharmacological preventive treatment of sustained ventricular arrhythmias in chagasic disease... more Non-pharmacological preventive treatment of sustained ventricular arrhythmias in chagasic disease is a challenge. Given that the involvement of the autonomic nervous system is one of its determinants, thoracic sympathectomy could be a valuable tool in some selected cases.
Management of complex ventricular arrhythmias due to chagasic myocarditis is challenging. We here... more Management of complex ventricular arrhythmias due to chagasic myocarditis is challenging. We herein present the case of a young male who was presented with incessant well tolerated polymorphic ventricular tachycardia of unknown cause, who was unresponsive to conventional medical management and as a last resort was submitted to a thoracoscopic bilateral sympathectomy, and showed remarkable improvement in his arrhythmia control. Later on his tests returned positive for Chagas' disease and shortly thereafter he suddenly died.
no es un órgano oficial del Departamento Nacional de Planeación. Sus documentos son de carácter p... more no es un órgano oficial del Departamento Nacional de Planeación. Sus documentos son de carácter provisional, de responsabilidad exclusiva de sus autores y sus contenidos no comprometen a la institución.
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