Study protocol: NITric oxide during cardiopulmonary bypass to improve Recovery in Infants with Congenital heart defects (NITRIC trial): a randomised controlled trial

Introduction Congenital heart disease (CHD) is a major cause of infant mortality. Many infants with CHD require corrective surgery with most operations requiring cardiopulmonary bypass (CPB). CPB triggers a systemic inflammatory response which is associated with low cardiac output syndrome (LCOS), postoperative morbidity and mortality. Delivery of nitric oxide (NO) into CPB circuits can provide myocardial protection and reduce bypass-induced inflammation, leading to less LCOS and improved recovery. We hypothesised that using NO during CPB increases ventilator-free days (VFD) (the number of days patients spend alive and free from invasive mechanical ventilation up until day 28) compared with standard care. Here, we describe the NITRIC trial protocol. Methods and analysis The NITRIC trial is a randomised, double-blind, controlled, parallel-group, two-sided superiority trial to be conducted in six paediatric cardiac surgical centres. One thousand three-hundred and twenty infants <2 years of age undergoing cardiac surgery with CPB will be randomly assigned to NO at 20 ppm administered into the CPB oxygenator for the duration of CPB or standard care (no NO) in a 1:1 ratio with stratification by age (<6 and ≥6 weeks), single ventricle physiology (Y/N) and study centre. The primary outcome will be VFD to day 28. Secondary outcomes include a composite of LCOS, need for extracorporeal membrane oxygenation or death within 28 days of surgery; length of stay in intensive care and in hospital; and, healthcare costs. Analyses will be conducted on an intention-to-treat basis. Preplanned secondary analyses will investigate the impact of NO on host inflammatory profiles postsurgery. Ethics and dissemination The study has ethical approval (HREC/17/QRCH/43, dated 26 April 2017), is registered in the Australian New Zealand Clinical Trials Registry (ACTRN12617000821392) and commenced recruitment in July 2017. The primary manuscript will be submitted for publication in a peer-reviewed journal. Trial registration number ACTRN12617000821392.</p

Outsmarting Network Security with SDN Teleportation

Software-defined networking is considered a promising new paradigm, enabling more reliable and formally verifiable communication networks. However, this paper shows that the separation of the control plane from the data plane, which lies at the heart of Software-Defined Networks (SDNs), introduces a new vulnerability which we call \emph{teleportation}. An attacker (e.g., a malicious switch in the data plane or a host connected to the network) can use teleportation to transmit information via the control plane and bypass critical network functions in the data plane (e.g., a firewall), and to violate security policies as well as logical and even physical separations. This paper characterizes the design space for teleportation attacks theoretically, and then identifies four different teleportation techniques. We demonstrate and discuss how these techniques can be exploited for different attacks (e.g., exfiltrating confidential data at high rates), and also initiate the discussion of possible countermeasures. Generally, and given today's trend toward more intent-based networking, we believe that our findings are relevant beyond the use cases considered in this paper.Comment: Accepted in EuroSP'1

High-Performance Integrated Window and Façade Solutions for California

The researchers developed a new generation of high-performance façade systems and supporting design and management tools to support industry in meeting California’s greenhouse gas reduction targets, reduce energy consumption, and enable an adaptable response to minimize real-time demands on the electricity grid. The project resulted in five outcomes: (1) The research team developed an R-5, 1-inch thick, triplepane, insulating glass unit with a novel low-conductance aluminum frame. This technology can help significantly reduce residential cooling and heating loads, particularly during the evening. (2) The team developed a prototype of a windowintegrated local ventilation and energy recovery device that provides clean, dry fresh air through the façade with minimal energy requirements. (3) A daylight-redirecting louver system was prototyped to redirect sunlight 15–40 feet from the window. Simulations estimated that lighting energy use could be reduced by 35–54 percent without glare. (4) A control system incorporating physics-based equations and a mathematical solver was prototyped and field tested to demonstrate feasibility. Simulations estimated that total electricity costs could be reduced by 9-28 percent on sunny summer days through adaptive control of operable shading and daylighting components and the thermostat compared to state-of-the-art automatic façade controls in commercial building perimeter zones. (5) Supporting models and tools needed by industry for technology R&amp;D and market transformation activities were validated. Attaining California’s clean energy goals require making a fundamental shift from today’s ad-hoc assemblages of static components to turnkey, intelligent, responsive, integrated building façade systems. These systems offered significant reductions in energy use, peak demand, and operating cost in California

The medical science DMZ: a network design pattern for data-intensive medical science

Abstract: Objective We describe a detailed solution for maintaining high-capacity, data-intensive network flows (eg, 10, 40, 100 Gbps+) in a scientific, medical context while still adhering to security and privacy laws and regulations. Materials and Methods High-end networking, packet-filter firewalls, network intrusion-detection systems. Results We describe a “Medical Science DMZ” concept as an option for secure, high-volume transport of large, sensitive datasets between research institutions over national research networks, and give 3 detailed descriptions of implemented Medical Science DMZs. Discussion The exponentially increasing amounts of “omics” data, high-quality imaging, and other rapidly growing clinical datasets have resulted in the rise of biomedical research “Big Data.” The storage, analysis, and network resources required to process these data and integrate them into patient diagnoses and treatments have grown to scales that strain the capabilities of academic health centers. Some data are not generated locally and cannot be sustained locally, and shared data repositories such as those provided by the National Library of Medicine, the National Cancer Institute, and international partners such as the European Bioinformatics Institute are rapidly growing. The ability to store and compute using these data must therefore be addressed by a combination of local, national, and industry resources that exchange large datasets. Maintaining data-intensive flows that comply with the Health Insurance Portability and Accountability Act (HIPAA) and other regulations presents a new challenge for biomedical research. We describe a strategy that marries performance and security by borrowing from and redefining the concept of a Science DMZ, a framework that is used in physical sciences and engineering research to manage high-capacity data flows. Conclusion By implementing a Medical Science DMZ architecture, biomedical researchers can leverage the scale provided by high-performance computer and cloud storage facilities and national high-speed research networks while preserving privacy and meeting regulatory requirements

Integrated control and health management. Orbit transfer rocket engine technology program

To insure controllability of the baseline design for a 7500 pound thrust, 10:1 throttleable, dual expanded cycle, Hydrogen-Oxygen, orbit transfer rocket engine, an Integrated Controls and Health Monitoring concept was developed. This included: (1) Dynamic engine simulations using a TUTSIM derived computer code; (2) analysis of various control methods; (3) Failure Modes Analysis to identify critical sensors; (4) Survey of applicable sensors technology; and, (5) Study of Health Monitoring philosophies. The engine design was found to be controllable over the full throttling range by using 13 valves, including an oxygen turbine bypass valve to control mixture ratio, and a hydrogen turbine bypass valve, used in conjunction with the oxygen bypass to control thrust. Classic feedback control methods are proposed along with specific requirements for valves, sensors, and the controller. Expanding on the control system, a Health Monitoring system is proposed including suggested computing methods and the following recommended sensors: (1) Fiber optic and silicon bearing deflectometers; (2) Capacitive shaft displacement sensors; and (3) Hot spot thermocouple arrays. Further work is needed to refine and verify the dynamic simulations and control algorithms, to advance sensor capabilities, and to develop the Health Monitoring computational methods

Systemization of Pluggable Transports for Censorship Resistance

An increasing number of countries implement Internet censorship at different scales and for a variety of reasons. In particular, the link between the censored client and entry point to the uncensored network is a frequent target of censorship due to the ease with which a nation-state censor can control it. A number of censorship resistance systems have been developed thus far to help circumvent blocking on this link, which we refer to as link circumvention systems (LCs). The variety and profusion of attack vectors available to a censor has led to an arms race, leading to a dramatic speed of evolution of LCs. Despite their inherent complexity and the breadth of work in this area, there is no systematic way to evaluate link circumvention systems and compare them against each other. In this paper, we (i) sketch an attack model to comprehensively explore a censor's capabilities, (ii) present an abstract model of a LC, a system that helps a censored client communicate with a server over the Internet while resisting censorship, (iii) describe an evaluation stack that underscores a layered approach to evaluate LCs, and (iv) systemize and evaluate existing censorship resistance systems that provide link circumvention. We highlight open challenges in the evaluation and development of LCs and discuss possible mitigations.Comment: Content from this paper was published in Proceedings on Privacy Enhancing Technologies (PoPETS), Volume 2016, Issue 4 (July 2016) as "SoK: Making Sense of Censorship Resistance Systems" by Sheharbano Khattak, Tariq Elahi, Laurent Simon, Colleen M. Swanson, Steven J. Murdoch and Ian Goldberg (DOI 10.1515/popets-2016-0028

Examining adherence to activity monitoring devices to improve physical activity in adults with cardiovascular disease: A systematic review

Background Activity monitoring devices are currently being used to facilitate and monitor physical activity. No prior review has examined adherence to the use of activity monitoring devices amongst adults with cardiovascular disease. Methods Literature from June 2012 to October 2017 was evaluated to examine the extent of adherence to any activity monitoring device used to collect objective physical activity data. Randomized control trials comparing usual care against the use of an activity monitoring device, in a community intervention for adults from any cardiovascular diagnostic group, were included. A systematic search of databases and clinical trials registers was conducted using Joanna Briggs Institute methodology. Results Of 10 eligible studies, two studies reported pedometer use and eight accelerometer use. Six studies addressed the primary outcome. Mean adherence was 59.1% (range 39.6% to 85.7%) at last follow-up. Studies lacked equal representation by gender (28.6% female) and age (range 42 to 82 years). Conclusion This review indicates that current research on activity monitoring devices may be overstated due to the variability in adherence. Results showed that physical activity tracking in women and in young adults have been understudied

Use of a right ventricular continuous flow pump to validate the distensible model of the pulmonary vasculature

In the pulmonary circulation, resistive and compliant properties overlap in the same vessels. Resistance varies nonlinearly with pressure and flow; this relationship is driven by the elastic properties of the vessels. Linehan et al. (1982) correlated the mean pulmonary arterial pressure and mean flow with resistance using an original equation incorporating the distensibility of the pulmonary arteries. The goal of this study was to validate this equation in an in vivo porcine model. In vivo measurements were acquired in 6 pigs. The distensibility coefficient (DC) was measured by placing piezo-electric crystals around the pulmonary artery (PA). In addition to experiments under pulsatile conditions, a right ventricular (RV) bypass system was used to induce a continuous pulmonary flow state. The Linehan's equation was then used to predict the pressure from the flow under continuous flow conditions. The diameter-derived DC was 2.4 %/mmHg (+/- 0.4 %), whereas the surface area-based DC was 4.1 %/mmHg (+/- 0.1 %). An increase in continuous flow was associated with a constant decrease in resistance, which correlated with the diameter-based DC (r=-0.8407, p=0.044) and the surface area-based DC (r=-0.8986, p=0.028). In contrast to the Linehan's equation, our results showed constant or even decreasing pressure as flow increased. Using a model of continuous pulmonary flow induced by an RV assist system, pulmonary pressure could not be predicted based on the flow using the Linehan's equation. Measurements of distensibility based on the diameter of the PA were inversely correlated with the resistance