Fuente de corriente para aplicaciones de bioimpedancia utilizando un dispositivo de señal mixta, PSoC 5LP

One of the main components for bioimpedance measurement are the current sources, which are designed mainly from discrete analog components. Currently, the decrease in the costs of digital systems and the high scale of integration allow us to propose embedded solutions, substantially reducing the electronic components used. This article presents the design of a bipolar sinusoidal current source for bioimpedance applications based on discrete time feedback systems, fully embedded in a mixed signal device PSoC 5LP CY8C5888AXI-LP096 from Cypress semiconductor mounted on a FreeSoC2 card from SparkFun. The proposed source regulates the peak level of the bipolar current delivered by an embedded discrete time controller, measuring the voltage present in a resistor of known value which is the only element external to the source and this series with the load impedance (Resistance Shunt), achieving working frequencies up to 120 kHz, with load resistors from 50 Ω to 3 kΩ and currents between 500 μA and 2 mA, maintaining a harmonic distortion close to 1% for most of the working range of the source.Uno de los principales componentes para medición de bioimpedancia son las fuentes de corriente, las cuales son diseñadas principalmente a partir de componentes analógicos discretos. En la actualidad la disminución en los costos de los sistemas digitales y la alta escala de integración permiten plantear soluciones embebidas disminuyendo sustancialmente los componentes electrónicos utilizados. Este articulo presenta el diseño de una fuente de corriente sinusoidal bipolar para aplicaciones de bioimpedancia basada en sistemas realimentados de tiempo discreto, totalmente embebida en un dispositivo de señal mixta PSoC 5LP CY8C5888AXI-LP096 de Cypress semiconductor montado sobre una tarjeta FreeSoC2 de la empresa SparkFun. La fuente propuesta regula el nivel pico de la corriente bipolar entregada mediante un controlador de tiempo discreto embebido, midiendo el voltaje presente en una resistencia de valor conocido la cual es el único elemento externo a la fuente y que esta serie con la impedancia de carga (Resistencia Shunt), lográndose frecuencias de trabajo de hasta 120 kHz, con resistencias de carga desde 50 Ω a 3 kΩ y corrientes entre 500 µA y 2 mA, manteniendo una distorsión armónica cercana al 1% para la mayoría del rango de trabajo de la fuente. 

Control en tiempo discreto de lazos de realimentación de corriente en el contexto de la bioimpedancia

El objetivo de este trabajo de maestría es proponer una fuente de corriente para estudios de bioimpedancia basada en técnicas de control realimentado de tiempo discreto, buscando verificar si la aplicación de estas técnicas de control, permite optimizar respecto al estado del arte el rendimiento en estabilidad, ancho de banda e impedancia de salida de la fuente de señales propuesta. Para lograr estos objetivos se realizó una exploración detallada de las arquitecturas y plataformas utilizadas en el diseño de fuentes de señales digitales para estudios de bioimpedancia existentes en el estado del arte, proponiéndose una arquitectura completamente embebida en la plataforma PSoC 5LP, la cual regula el nivel pico de la corriente entregada por la fuente mediante un controlador proporcional que mide el voltaje presente en una resistencia de valor conocido la cual se encuentra en serie con la impedancia de carga (Resistencia Shunt), lográndose una frecuencia de trabajo máxima de 120 kHz

Memorias. Encuentro de Experiencias en Inventarios y Monitoreo Biológico

Las discusiones temáticas alrededor de la consolidación del Inventario Nacional de Biodiversidad para Colombia y la Red de Monitoreo de Biodiversidad como una estrategia de largo plazo, sin duda temas complejos que requerirán de grandes esfuerzos, coordinación y generosidad institucional y personal, los podrá apreciar el lector a lo largo del presente documento, esperando que pueda entender también la importancia que tienen los resultados y la agenda propuesta si en el futuro queremos tomar decisiones con bases científicas

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research