It is envisaged that end-user access bandwidth requirements will notably increase in the coming years; at the same time, the number of connected mobile devices will also exponentially grow as the ...fully-digital connected homes (Internet of Things) becomes an everyday reality. This article presents an active remote node (ARN) at an intermediate location between the central office and end-user premises, as a flexible and future-proofed infrastructure topology approach for solving the associated bandwidth and wired-wireless convergence issues. The ARN represents the key architectural design innovation of the SODALES (SOftware-Defined Access using Low-Energy Subsystems) network. The rise of mobile communications, and the trend for seamless convergence between fixed and wireless networks is tending to make the purely passive approaches (e.g. as exemplified by passive optical networking (PON) access architectures) too restrictive, considering the modularity and flexibility offered by an active remote node. We present a performance analysis of the ARN node, to support the cost-effectiveness of the proposed SODALES solution and to demonstrate the potential benefits in terms network performance, operational efficiency, and flexible functionality. Looking forward, future ARN capabilities can also be expected to include hierarchical caching, customer premises equipment (CPE) visualization, and nearer to the end-user location of software-defined platforms supporting ubiquitous cloud services.
Objetivo. Analizar el impacto de la aplicación de medidas de mejora implementadas a partir de la evaluación de indicadores de calidad (IC) en la atención prestada a los pacientes pediátricos con ...intoxicación aguda. Método. Se compara el resultado actual de los IC con el estándar deseado y con el resultado obtenido en dos estudios previos. Estudio-1: evaluación de 6 IC básicos en los servicios de urgencias pediátricas (SUP) participantes en el Grupo de Trabajo de Intoxicaciones de la Sociedad Española de Urgencias Pediátricas (GTI-SEUP). Estudio-2: evaluación de los 20 IC en uno de los servicios de urgencias del GTI-SEUP. Tras la realización de los mismos se implementaron medidas correctoras: grupo de seguimiento de lavado gástrico, reedición del manual de intoxicaciones del GTI-SEUP, implementación del protocolo de atención al paciente intoxicado y creación de campos específicos en la historia clínica informatizada. Resultados. Estudio-1: se alcanza el estándar en 4 IC y mejora la disponibilidad de protocolos (el IC supera el estándar en el 100% de SUP vs el 29,2% previo; p < 0,001) sin cambios significativos en el resto de IC. Estudio-2: se alcanza el estándar en 13 IC y mejora de los IC sobre cumplimentación de parte judicial (44,4% vs 19,2%; p = 0,036), registro del Conjunto Mínimo de Datos (51,0% vs 1,9%; p < 0,001) y tendencia al aumento de administración de carbón activado en las primeras 2 horas (93,1% vs 83,5%; p = 0,099). No existen cambios significativos en el resto de IC. Conclusiones. La implementación de medidas correctoras ha dado lugar a una mejora en el resultado de algunos IC. La calidad de la asistencia de estos pacientes es aún mejorable.
We report the molecular diagnosis of a lecithin : cholesterol acyltransferase deficiency in a 12-year old proband with a high-density lipoprotein deficiency. The increased percentage of free ...cholesterol in plasma and high-density lipoprotein indicated an inherited lecithin : cholesterol acyltransferase deficiency as the underlying cause. This diagnosis was confirmed by a low plasma lecithin : cholesterol acyltransferase activity and a combination of genetic analyses which demonstrated compound heterozygosity for two mutations in the lecithin : cholesterol acyltransferase gene of the proband. One was a previously unreported 2 bp deletion leading to a stop signal in codon 77 and the other a point mutation causing Arg 135 → Gln transition. To our knowledge, this is the first diagnosis of lecithin : cholesterol acyltransferase deficiency in a pre-symptomatic patient. Whether the proband will develop signs of complete lecithin : cholesterol acyltransferase deficiency or the milder form (Fish Eye Disease) is uncertain, although the former possibility is more likely. The risk of premature atherosclerosis conferred by lecithin : cholesterol acyltransferase deficiency is not well established. The proband will need to be carefully monitored in the future.
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