Using DEVS for full life cycle model-based system engineering in complex network design

The Discrete Event System Specification (DEVS) is a modeling formalism that supports a general methodology for describing discrete event systems with the capability to represent continuous, discrete, and hybrid systems due to its system theoretic basis. In this chapter, we discuss the use of DEVS as the basic modeling and simulation framework for Model-Based System Engineering methodology that supports the critical stages in a top down design of complex networks. Focusingon the design of communication networks for emergency response, we show how such networks pose challenges to current technologies that current simulators cannot address. This sets the stage for considering how the DEVS formalism supports the required phases of top down design and the transitions from one phase to the next. After describing the proposed DEVS-based system engineering methodology in depth, we conclude with a discussion of the current state of its application, alsomentioning open research needed to bring it into general practice.Fil: Alshareef, Abdurrahman. King Saud University; Arabia SauditaFil: Blas, María Julia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Instituto de Desarrollo y Diseño. Universidad Tecnológica Nacional. Facultad Regional Santa Fe. Instituto de Desarrollo y Diseño; ArgentinaFil: Bonaventura, Matias Alejandro. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Investigación en Ciencias de la Computación. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Investigación en Ciencias de la Computación; ArgentinaFil: Paris, Thomas. Université de Lorraine; FranciaFil: Yacoub, Aznam. University Of Windsor; CanadáFil: Zeigler, Bernard. No especifíca

The effect of a rapid molecular blood test on the use of antibiotics for nosocomial sepsis: A randomized clinical trial

Background: Appropriate use of antimicrobials is essential to improve outcomes in sepsis. The aim of this study was to determine whether the use of a rapid molecular blood test - SeptiFast (SF) reduces the antibiotic consumption through early de-escalation in patients with nosocomial sepsis compared with conventional blood cultures (BCs). Methods: This was a prospective, randomized, superiority, controlled trial conducted at Sao Paulo Heart Institute in the period October 2012-May 2016. Adult patients admitted to the hospital for at least 48 h with a diagnosis of nosocomial sepsis underwent microorganism identification by both SF test and BCs. Patients randomized into the intervention group received antibiotic therapy adjustment according to the results of SF. Patients randomized into the control group received standard antibiotic adjustment according to the results of BCs. The primary endpoint was antimicrobial consumption during the first 14 days after randomization. Results: A total of 200 patients were included (100 in each group). The intention to treat analysis found no significant differences in median antibiotic consumption. In the subgroup of patients with positive SF and blood cultures (19 and 25 respectively), we found a statistically significant reduction in the median antimicrobial consumption which was 1429 (1071-2000) days of therapy (DOT)/1000 patients-day in the intervention group and 1889 (1357-2563) DOT/1000 patients-day in the control group (p = 0.017), in the median time of antimicrobial de-escalation (8 versus 54 h - p < 0.001), in the duration of antimicrobial therapy (p = 0.039) and in anti-gram-positive antimicrobial costs (p = 0.002). Microorganism identification was possible in 24.5% of patients (45/184) by SF and 21.2% (39/184) by BC (p = 0.45). Conclusion: This randomized clinical trial showed that the use of a rapid molecular-based pathogen identification test does not reduce the median antibiotic consumption in nosocomial sepsis. However, in patients with positive microbiological tests, the use of SeptiFast reduced antimicrobial consumption through early de-escalation compared to conventional blood cultures. These results were driven by a reduction in the consumption of antimicrobials used for Gram-positive bacteria. Trial registration: The trial was registered at ClinicalTrials.gov (NCT 01450358) on 12th October 2011SCOPUS: ar.jinfo:eu-repo/semantics/publishe