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Yadin David

The University of Texas Health Science Center at Houston, School of Public Health, Adjunct

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An experienced clinical engineer with healthcare technology program management expertise and international knowledge of the role of technological tools deployed to improve patient care experiences. Brings unique expertise in medical products regulations and compliance. Have been recognized with awards, certifications, and appointments at academia as well as the FDA advisory panels.

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Johns Hopkins University

Sharon Strocchia

Emory University

Efstratios Papanis

University of the Aegean

Viacheslav Kuleshov

Stockholm University

Jaime Rodrigues

Universidade Federal de São Paulo (UNIFESP)

Maria Pia Donato

Centre National de la Recherche Scientifique / French National Centre for Scientific Research

Cornell University

Sarah Vigmostad

The University of Iowa

Fundação Oswaldo Cruz

Dragos Simandan

Brock University

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Papers by Yadin David

Global Clinical Engineering Status: Post-COVID19 Review

Global Clinical Engineering Journal

Many colleagues have written about the global reliance on health technologies whose innovation, d... more Many colleagues have written about the global reliance on health technologies whose innovation, deployment and supportcontinue to improve worldwide healthcare and its delivery. The World Health Organization’s-WHO 2007 Resolution WHA60.29called for the effective use of health technologies (HT), in particular medical devices, through proper planning, assessment,acquisition and management.The community of professional clinical engineering (CE) practitioners’ pre-COVID19 stories are captured in the Global ClinicalEngineering Journal. An article from 2022 shows the reasons for the increased contributions of this community especially duringthe pandemic in The Growing Role of Clinical Engineering: Merging Technology at the Point of Care.This article will answer questions such as to how this global reliance was demonstrated during the COVID19 period. How thestatus of the Clinical/Biomedical Engineering (CE/BME) profession that serves at the point of care changed as the world emergesfrom the...

Incidence of Perioperative Myocardial Ischemia Detected by Different Electrocardiographic Systems

Anesthesiology, Dec 1, 1990

Hospital's medical technology evaluation process

Summary form only given. The role of the medical technology evaluation program in the purchase of... more Summary form only given. The role of the medical technology evaluation program in the purchase of medical equipment is threefold: 1) assuring that biomedical equipment facilitates the delivery of quality patient care, 2) assuring that the equipment purchased meets the needs of all users, and 3) establishing hospital standards for biomedical equipment. Medical technology evaluation occurs in two phases. Phase

National Clinical Alarms Surveys – 5 years Comparison of Issues, Improvements and Priorities

IFMBE Proceedings, 2013

The environment at the point-of-care in hospitals contains an increased number of annunciators in... more The environment at the point-of-care in hospitals contains an increased number of annunciators in the form of bells, beeps, buzzers and flashing indicators most of which are used to communicate changes in the acuity level of patients or in the systems that support the management of their condition. The source for these alarms can be patient-related, use-related or equipment-related and at times can be the result of combined contributions. Alarms have the clear purpose of improving patient care by calling care provider's attention to a situation that may require his or her intervention; however they lack the ability to prioritize this messaging to care providers who must discern whether these annunciations are clinically significant and necessitate timely intervention. Because of the widespread use of alarms, the occurrence of an alarm can have a widely varying degree of urgency. This can be particularly unfortunate when an alarm is misinterpreted as not being important when in fact it is. To better understand the contributing issues and their rate of change, the Healthcare Technology Foundation (www.HTF.org) conducted two national surveys about 5 years apart. The results of the first survey in 2006 (1327 responses) pointed mostly to the concern about the frequent occurrence of nuisance or false alarms. Five years later, in 2011, the results (4287 responses) of the second National Clinical Alarm survey showed similar responses having the highest concern for frequent false alarm that do not contribute to better care. The majority of care providers reported, again, that at lack of trust and care disruption are the two most frustrating parameters of alarm management.

Uptake and Distribution of Bupivacaine in Fetal Lambs

Obstetric Anesthesia Digest, Jul 1, 1987

Uptake and Distribution of Bupivacaine in Fetal Lambs

Anesthesiology, 1986

Uptake and Distribution of Etidocaine in the Fetal Lamb

Anesthesiology, 1982

EMC(electromagnetic compatibility): how to manage the challenge

PubMed, Jun 1, 1997

The significant changes in health care and telecommunications has produced an emergence of new an... more The significant changes in health care and telecommunications has produced an emergence of new and exciting technologies. Clinical engineers must continue to safeguard patient safety by adequately refurbishing their arsenal of technical knowledge of electromagnetic compatibility (EMC). This document examines the methodology and the tools for managing the technical changes in the telecommunications and biomedical equipment areas.

National Clinical Alarms Surveys – 5 years Comparison of Issues, Improvements and Priorities

Springer eBooks, 2013

The environment at the point-of-care in hospitals contains an increased number of annunciators in... more The environment at the point-of-care in hospitals contains an increased number of annunciators in the form of bells, beeps, buzzers and flashing indicators most of which are used to communicate changes in the acuity level of patients or in the systems that support the management of their condition. The source for these alarms can be patient-related, use-related or equipment-related and at times can be the result of combined contributions. Alarms have the clear purpose of improving patient care by calling care provider's attention to a situation that may require his or her intervention; however they lack the ability to prioritize this messaging to care providers who must discern whether these annunciations are clinically significant and necessitate timely intervention. Because of the widespread use of alarms, the occurrence of an alarm can have a widely varying degree of urgency. This can be particularly unfortunate when an alarm is misinterpreted as not being important when in fact it is. To better understand the contributing issues and their rate of change, the Healthcare Technology Foundation (www.HTF.org) conducted two national surveys about 5 years apart. The results of the first survey in 2006 (1327 responses) pointed mostly to the concern about the frequent occurrence of nuisance or false alarms. Five years later, in 2011, the results (4287 responses) of the second National Clinical Alarm survey showed similar responses having the highest concern for frequent false alarm that do not contribute to better care. The majority of care providers reported, again, that at lack of trust and care disruption are the two most frustrating parameters of alarm management.

<title>Telemedicine, health information networks, and computer-based patient records</title>

Proceedings of SPIE, Feb 9, 1996

My name is Luis Kun and I am chairing this conference. Today we are going to discuss issues deali... more My name is Luis Kun and I am chairing this conference. Today we are going to discuss issues dealing with telemedicine, health information networks and computer based patient records. We have people here representing very different aspects or views perhaps of the same problems. Some coming from the academic side like Dr. Warren Grundfest, who is a medical doctor. In other instances we have some people like Dr. David who represents a series of hospitals, Dr. Michael Fitzmaurice representing government, Jeff Blair representing industry, IBM, in terms of health systems. And we have Louis Lorton from Host, which represents a solution as I see it, combining government, industry and academia. It's a new way of perhaps solving problems in health care. He's part of the AlP program of NEST [Department of Commerce sponsored program]. What I would like to do now, is give a few minutes to each of the participants in the panel to introduce themselves so the audience will have an idea of who they are and how they are involved in this field and what institutions they represent. After that we will go into a round table format with the audience. I would like, if possible, for all of you, when making a comment or question, to introduce yourselves, stating your name and the institution that you represent. I'm going to be acting as a moderator. So, Dr. David, if you could start by introducing yourself.

Getting Started with IEC 80001

Near Infrared Spectroscopic [Nirs] Estimations of Cerebral Blood Flow in Very Low Birth Weight [VLBW] Infants. † 2275

Pediatric Research, Apr 1, 1996

Clinical Engineering Program Productivity And Measurements

Journal of clinical engineering, Nov 1, 1986

The health care delivery system is undergoing evolutionary changes that are also affecting Clinic... more The health care delivery system is undergoing evolutionary changes that are also affecting Clinical Engineering. The integration of engineering and the life sciences created an industry whose &quot;product&quot; must be quality patient care. The utilization of technologies in the clinical environment is perpetually growing, and has created a need for professional technical management. The present changing environment requires Clinical Engineers to become effective leaders and efficient managers. The efficient consumption of an organization&#39;s resources is dependent on its managers&#39; abilities to assess and optimize their operations under dynamic conditions. This paper describes some means for monitoring the clinical engineering department &quot;output&quot; and for measuring and reporting the relative changes in output, thus enhancing progress toward achievement of established goals. The tools and techniques offered here are not an end in themselves, but are rather a part of the process of maximizing productivity with a commitment to program output quality.

Global Clinical Engineering Status: Post-COVID19 Review

Global clinical engineering journal, Dec 13, 2022

Many colleagues have written about the global reliance on health technologies whose innovation, d... more Many colleagues have written about the global reliance on health technologies whose innovation, deployment and support continue to improve worldwide healthcare and its delivery. The World Health Organization's-WHO 2007 Resolution WHA60.29 called for the effective use of health technologies (HT), in particular medical devices, through proper planning, assessment, acquisition and management. The community of professional clinical engineering (CE) practitioners' pre-COVID19 stories are captured in the Global Clinical Engineering Journal. An article from 2022 shows the reasons for the increased contributions of this community especially during the pandemic in The Growing Role of Clinical Engineering: Merging Technology at the Point of Care. This article will answer questions such as to how this global reliance was demonstrated during the COVID19 period. How the status of the Clinical/Biomedical Engineering (CE/BME) profession that serves at the point of care changed as the world emerges from the huge stresses of the pandemic. The article reviews the evolution of the CE profession since 2020, how it partnered with WHO between 2020-2022 and what lessons were learned in the process. It reports future CE priorities to improve country, regional, and global practice in 2023 and beyond. This timely preliminary report shares important findings related to patient care support services.

Characteristics of Transcutaneous Electrical Nerve Stimulation Used Clinically for Pain Control

Elsevier eBooks, 1983

Publisher Summary This chapter presents the characteristics of transcutaneous electrical nerve st... more Publisher Summary This chapter presents the characteristics of transcutaneous electrical nerve stimulation used clinically for pain control. Studies on electrical stimulation and its effect on the tissue were originated from the development of the cardiac stimulation. To achieve optimum pain relief, the proper stimulus form is determined. The Physical Therapist's cart in a hospital contains a variety of transcutaneous electrical nerve stimulator (TENS) rather than a standardized device. The reason is that they have experienced a variety of responses from the treated patients dependent on the device used. In a study reviewed in the chapter, 13 models of TENS devices were tested for the purpose of identifying their characteristics and perhaps provide a reason for the difference in the patients' relief clinicians are experiencing. A tester was constructed in accordance with the AAMI proposed TENS standard, and simulated varying skin conditions by changing the sink impedance in the tester. The varying conditions included simulation of changes in skin conditions between wet, dry, and gelled. Those units that were able to dismantle undestructively, were studied for potential in-house servicing and construction quality. This study demonstrates that there is large variance of parameters between the TENS devices used clinically. Therefore, these parameters need to be defined in clinical studies that includes TENS devices. The generator, the electrodes, and the coupling medium together comprise a system. Each of these components contributes to the system's efficiency.

Education Successes Applied to Disaster Preparedness, Meeting Infectious Diseases and Malnutrition Challenges

IFMBE proceedings, May 30, 2018

Hurricanes, floods and earthquakes have devastated part of the Caribbean and Latin America Region... more Hurricanes, floods and earthquakes have devastated part of the Caribbean and Latin America Region: “Maria” hurricane in Puerto Rico, flooding disaster in Peru, the several serious earthquakes in Mexico, Colombia, Chile, Argentina, occurred recently; it is required to ensure the effective functioning of the health systems at the potential situation of an emergency. Natural disasters and other emergencies around the world put the populations at risk; they may cause diseases and/or the disruption of health systems, facilities and services. The health risks of a disaster can be mitigated by building capacities of individuals, community and the country with developed or developing economies to protect health, Preparedness should address all the health disciplines. Responding to the effects of climate change on 2017 the National Institute of Health of Peru trained health workers from the 6 regions seriously affected by dengue disease, the result improved the effectiveness of the regional laboratories through the on time distribution and correct use of supplies to respond to the emergency. On 2014, the Philippines trained to prepare health professionals working in hospitals to detect and safely manage Ebola virus disease (EVD): public, private and local government hospitals were engaged. The confidence in managing EVD increased significantly (P = 0.018) with 96% of participants feeling more prepared to safely manage EVD cases. In other country like Ethiopia the adequate preparedness in emergencies and disaster response improved the capacities and better understanding of context specific causes of acute malnutrition and contributed to prevent the increase of severe acute malnutrition in the Horn of Africa in 2011 and other places in 2013 and 2014.

The Growing Role of Clinical Engineering: Merging Technology at the Point of Care

Global Clinical Engineering Journal

Re-publication of the article published in National Academy of Engineering Perspectives, May 27, ... more

Resting energy expenditure in children in a pediatric intensive care unit: comparison of Harris-Benedict and Talbot predictions with indirect calorimetry values

The American Journal of Clinical Nutrition, 1998

The use of prediction equations has been recommended for calculating energy expenditure. We evalu... more The use of prediction equations has been recommended for calculating energy expenditure. We evaluated two equations that predict energy expenditure, each of which were corrected for two different stress factors, and compared the values obtained with those calculated by indirect calorimetry. The subjects were 55 critically ill children on mechanical ventilation. Basal metabolic rates were calculated with the Harris-Benedict and Talbot methods. Measured resting energy expenditure was 4.72 ± 2.53 MJ/d. The average difference between measured resting energy expenditure and the Harris-Benedict prediction with a stress factor of 1.5 was Ϫ0.98 MJ/d, with an SD ⌬ of 1.56 MJ/d and limits of agreement from Ϫ4.12 to 2.15; for a stress factor of 1.3 the average difference was Ϫ0.22 MJ/d, with an SD ⌬ of 1.57 MJ/d and limits of agreement from Ϫ3.37 to 2.93. The average difference between measured resting energy expenditure and the Talbot prediction with a stress factor of 1.5 was Ϫ0.23 MJ/d, with an SD ⌬ of 1.36 MJ/d and limits of agreement from Ϫ2.95 to 2.48; for a stress factor of 1.3, it was 0.42 MJ/d, with an SD ⌬ of 1.24 MJ/d and limits of agreement from Ϫ2.04 to 2.92. These limits of agreement indicate large differences in energy expenditure between the measured value and the prediction estimated for some patients. Therefore, neither the Harris-Benedict nor the Talbot method will predict resting energy expenditure with acceptable precision for clinical use. Indirect calorimetry appears to be the only useful way of determining resting energy expenditure in these patients.

New Concepts in Patient Monitoring System

Biomedical Engineering II, 1983

Publisher Summary The introduction of “computer-on-a-chip” concept was the event that signaled a ... more Publisher Summary The introduction of “computer-on-a-chip” concept was the event that signaled a breakthrough in the application of biomedical technology. Its small size, reliability, flexibility, low power requirements, and cost made it attractive for consideration in a variety of tasks, and even with present-day budget constraints. Instruments have become microcomputer-controlled, or microcomputer based. This chapter presents a system where an algorithm was added to the processing functions, after the initial acquisition of the system, by field replacement of a programmable chip. Implementing a comparable change in a hardware driven instrument would probably require sufficient electromechanical redesign so as to warrant release of a new instrument model. Preprogrammed signal processing algorithms can include, for example, adaptive digital filtering techniques that would be less attractive in an analog instrumentation. The system ECG processing algorithm includes a task that branches upon the detection of an artificial pacemaker during the patient's cardiac activity. To increase system efficiency, the tasks are allocated to separate microprocessors.

Getting Started with IEC 80001

Getting Started with IEC 80001

Global Clinical Engineering Status: Post-COVID19 Review

Global Clinical Engineering Journal

Many colleagues have written about the global reliance on health technologies whose innovation, d... more Many colleagues have written about the global reliance on health technologies whose innovation, deployment and supportcontinue to improve worldwide healthcare and its delivery. The World Health Organization’s-WHO 2007 Resolution WHA60.29called for the effective use of health technologies (HT), in particular medical devices, through proper planning, assessment,acquisition and management.The community of professional clinical engineering (CE) practitioners’ pre-COVID19 stories are captured in the Global ClinicalEngineering Journal. An article from 2022 shows the reasons for the increased contributions of this community especially duringthe pandemic in The Growing Role of Clinical Engineering: Merging Technology at the Point of Care.This article will answer questions such as to how this global reliance was demonstrated during the COVID19 period. How thestatus of the Clinical/Biomedical Engineering (CE/BME) profession that serves at the point of care changed as the world emergesfrom the...

Incidence of Perioperative Myocardial Ischemia Detected by Different Electrocardiographic Systems

Anesthesiology, Dec 1, 1990

Hospital's medical technology evaluation process

Summary form only given. The role of the medical technology evaluation program in the purchase of... more Summary form only given. The role of the medical technology evaluation program in the purchase of medical equipment is threefold: 1) assuring that biomedical equipment facilitates the delivery of quality patient care, 2) assuring that the equipment purchased meets the needs of all users, and 3) establishing hospital standards for biomedical equipment. Medical technology evaluation occurs in two phases. Phase

National Clinical Alarms Surveys – 5 years Comparison of Issues, Improvements and Priorities

IFMBE Proceedings, 2013

The environment at the point-of-care in hospitals contains an increased number of annunciators in... more The environment at the point-of-care in hospitals contains an increased number of annunciators in the form of bells, beeps, buzzers and flashing indicators most of which are used to communicate changes in the acuity level of patients or in the systems that support the management of their condition. The source for these alarms can be patient-related, use-related or equipment-related and at times can be the result of combined contributions. Alarms have the clear purpose of improving patient care by calling care provider's attention to a situation that may require his or her intervention; however they lack the ability to prioritize this messaging to care providers who must discern whether these annunciations are clinically significant and necessitate timely intervention. Because of the widespread use of alarms, the occurrence of an alarm can have a widely varying degree of urgency. This can be particularly unfortunate when an alarm is misinterpreted as not being important when in fact it is. To better understand the contributing issues and their rate of change, the Healthcare Technology Foundation (www.HTF.org) conducted two national surveys about 5 years apart. The results of the first survey in 2006 (1327 responses) pointed mostly to the concern about the frequent occurrence of nuisance or false alarms. Five years later, in 2011, the results (4287 responses) of the second National Clinical Alarm survey showed similar responses having the highest concern for frequent false alarm that do not contribute to better care. The majority of care providers reported, again, that at lack of trust and care disruption are the two most frustrating parameters of alarm management.

Uptake and Distribution of Bupivacaine in Fetal Lambs

Obstetric Anesthesia Digest, Jul 1, 1987

Uptake and Distribution of Bupivacaine in Fetal Lambs

Anesthesiology, 1986

Uptake and Distribution of Etidocaine in the Fetal Lamb

Anesthesiology, 1982

EMC(electromagnetic compatibility): how to manage the challenge

PubMed, Jun 1, 1997

The significant changes in health care and telecommunications has produced an emergence of new an... more The significant changes in health care and telecommunications has produced an emergence of new and exciting technologies. Clinical engineers must continue to safeguard patient safety by adequately refurbishing their arsenal of technical knowledge of electromagnetic compatibility (EMC). This document examines the methodology and the tools for managing the technical changes in the telecommunications and biomedical equipment areas.

National Clinical Alarms Surveys – 5 years Comparison of Issues, Improvements and Priorities

Springer eBooks, 2013

The environment at the point-of-care in hospitals contains an increased number of annunciators in... more The environment at the point-of-care in hospitals contains an increased number of annunciators in the form of bells, beeps, buzzers and flashing indicators most of which are used to communicate changes in the acuity level of patients or in the systems that support the management of their condition. The source for these alarms can be patient-related, use-related or equipment-related and at times can be the result of combined contributions. Alarms have the clear purpose of improving patient care by calling care provider's attention to a situation that may require his or her intervention; however they lack the ability to prioritize this messaging to care providers who must discern whether these annunciations are clinically significant and necessitate timely intervention. Because of the widespread use of alarms, the occurrence of an alarm can have a widely varying degree of urgency. This can be particularly unfortunate when an alarm is misinterpreted as not being important when in fact it is. To better understand the contributing issues and their rate of change, the Healthcare Technology Foundation (www.HTF.org) conducted two national surveys about 5 years apart. The results of the first survey in 2006 (1327 responses) pointed mostly to the concern about the frequent occurrence of nuisance or false alarms. Five years later, in 2011, the results (4287 responses) of the second National Clinical Alarm survey showed similar responses having the highest concern for frequent false alarm that do not contribute to better care. The majority of care providers reported, again, that at lack of trust and care disruption are the two most frustrating parameters of alarm management.

<title>Telemedicine, health information networks, and computer-based patient records</title>

Proceedings of SPIE, Feb 9, 1996

My name is Luis Kun and I am chairing this conference. Today we are going to discuss issues deali... more My name is Luis Kun and I am chairing this conference. Today we are going to discuss issues dealing with telemedicine, health information networks and computer based patient records. We have people here representing very different aspects or views perhaps of the same problems. Some coming from the academic side like Dr. Warren Grundfest, who is a medical doctor. In other instances we have some people like Dr. David who represents a series of hospitals, Dr. Michael Fitzmaurice representing government, Jeff Blair representing industry, IBM, in terms of health systems. And we have Louis Lorton from Host, which represents a solution as I see it, combining government, industry and academia. It's a new way of perhaps solving problems in health care. He's part of the AlP program of NEST [Department of Commerce sponsored program]. What I would like to do now, is give a few minutes to each of the participants in the panel to introduce themselves so the audience will have an idea of who they are and how they are involved in this field and what institutions they represent. After that we will go into a round table format with the audience. I would like, if possible, for all of you, when making a comment or question, to introduce yourselves, stating your name and the institution that you represent. I'm going to be acting as a moderator. So, Dr. David, if you could start by introducing yourself.

Getting Started with IEC 80001

Near Infrared Spectroscopic [Nirs] Estimations of Cerebral Blood Flow in Very Low Birth Weight [VLBW] Infants. † 2275

Pediatric Research, Apr 1, 1996

Clinical Engineering Program Productivity And Measurements

Journal of clinical engineering, Nov 1, 1986

The health care delivery system is undergoing evolutionary changes that are also affecting Clinic... more The health care delivery system is undergoing evolutionary changes that are also affecting Clinical Engineering. The integration of engineering and the life sciences created an industry whose &quot;product&quot; must be quality patient care. The utilization of technologies in the clinical environment is perpetually growing, and has created a need for professional technical management. The present changing environment requires Clinical Engineers to become effective leaders and efficient managers. The efficient consumption of an organization&#39;s resources is dependent on its managers&#39; abilities to assess and optimize their operations under dynamic conditions. This paper describes some means for monitoring the clinical engineering department &quot;output&quot; and for measuring and reporting the relative changes in output, thus enhancing progress toward achievement of established goals. The tools and techniques offered here are not an end in themselves, but are rather a part of the process of maximizing productivity with a commitment to program output quality.

Global Clinical Engineering Status: Post-COVID19 Review

Global clinical engineering journal, Dec 13, 2022

Many colleagues have written about the global reliance on health technologies whose innovation, d... more Many colleagues have written about the global reliance on health technologies whose innovation, deployment and support continue to improve worldwide healthcare and its delivery. The World Health Organization's-WHO 2007 Resolution WHA60.29 called for the effective use of health technologies (HT), in particular medical devices, through proper planning, assessment, acquisition and management. The community of professional clinical engineering (CE) practitioners' pre-COVID19 stories are captured in the Global Clinical Engineering Journal. An article from 2022 shows the reasons for the increased contributions of this community especially during the pandemic in The Growing Role of Clinical Engineering: Merging Technology at the Point of Care. This article will answer questions such as to how this global reliance was demonstrated during the COVID19 period. How the status of the Clinical/Biomedical Engineering (CE/BME) profession that serves at the point of care changed as the world emerges from the huge stresses of the pandemic. The article reviews the evolution of the CE profession since 2020, how it partnered with WHO between 2020-2022 and what lessons were learned in the process. It reports future CE priorities to improve country, regional, and global practice in 2023 and beyond. This timely preliminary report shares important findings related to patient care support services.

Characteristics of Transcutaneous Electrical Nerve Stimulation Used Clinically for Pain Control

Elsevier eBooks, 1983

Publisher Summary This chapter presents the characteristics of transcutaneous electrical nerve st... more Publisher Summary This chapter presents the characteristics of transcutaneous electrical nerve stimulation used clinically for pain control. Studies on electrical stimulation and its effect on the tissue were originated from the development of the cardiac stimulation. To achieve optimum pain relief, the proper stimulus form is determined. The Physical Therapist's cart in a hospital contains a variety of transcutaneous electrical nerve stimulator (TENS) rather than a standardized device. The reason is that they have experienced a variety of responses from the treated patients dependent on the device used. In a study reviewed in the chapter, 13 models of TENS devices were tested for the purpose of identifying their characteristics and perhaps provide a reason for the difference in the patients' relief clinicians are experiencing. A tester was constructed in accordance with the AAMI proposed TENS standard, and simulated varying skin conditions by changing the sink impedance in the tester. The varying conditions included simulation of changes in skin conditions between wet, dry, and gelled. Those units that were able to dismantle undestructively, were studied for potential in-house servicing and construction quality. This study demonstrates that there is large variance of parameters between the TENS devices used clinically. Therefore, these parameters need to be defined in clinical studies that includes TENS devices. The generator, the electrodes, and the coupling medium together comprise a system. Each of these components contributes to the system's efficiency.

Education Successes Applied to Disaster Preparedness, Meeting Infectious Diseases and Malnutrition Challenges

IFMBE proceedings, May 30, 2018

Hurricanes, floods and earthquakes have devastated part of the Caribbean and Latin America Region... more Hurricanes, floods and earthquakes have devastated part of the Caribbean and Latin America Region: “Maria” hurricane in Puerto Rico, flooding disaster in Peru, the several serious earthquakes in Mexico, Colombia, Chile, Argentina, occurred recently; it is required to ensure the effective functioning of the health systems at the potential situation of an emergency. Natural disasters and other emergencies around the world put the populations at risk; they may cause diseases and/or the disruption of health systems, facilities and services. The health risks of a disaster can be mitigated by building capacities of individuals, community and the country with developed or developing economies to protect health, Preparedness should address all the health disciplines. Responding to the effects of climate change on 2017 the National Institute of Health of Peru trained health workers from the 6 regions seriously affected by dengue disease, the result improved the effectiveness of the regional laboratories through the on time distribution and correct use of supplies to respond to the emergency. On 2014, the Philippines trained to prepare health professionals working in hospitals to detect and safely manage Ebola virus disease (EVD): public, private and local government hospitals were engaged. The confidence in managing EVD increased significantly (P = 0.018) with 96% of participants feeling more prepared to safely manage EVD cases. In other country like Ethiopia the adequate preparedness in emergencies and disaster response improved the capacities and better understanding of context specific causes of acute malnutrition and contributed to prevent the increase of severe acute malnutrition in the Horn of Africa in 2011 and other places in 2013 and 2014.

The Growing Role of Clinical Engineering: Merging Technology at the Point of Care

Global Clinical Engineering Journal

Re-publication of the article published in National Academy of Engineering Perspectives, May 27, ... more

Resting energy expenditure in children in a pediatric intensive care unit: comparison of Harris-Benedict and Talbot predictions with indirect calorimetry values

The American Journal of Clinical Nutrition, 1998

The use of prediction equations has been recommended for calculating energy expenditure. We evalu... more The use of prediction equations has been recommended for calculating energy expenditure. We evaluated two equations that predict energy expenditure, each of which were corrected for two different stress factors, and compared the values obtained with those calculated by indirect calorimetry. The subjects were 55 critically ill children on mechanical ventilation. Basal metabolic rates were calculated with the Harris-Benedict and Talbot methods. Measured resting energy expenditure was 4.72 ± 2.53 MJ/d. The average difference between measured resting energy expenditure and the Harris-Benedict prediction with a stress factor of 1.5 was Ϫ0.98 MJ/d, with an SD ⌬ of 1.56 MJ/d and limits of agreement from Ϫ4.12 to 2.15; for a stress factor of 1.3 the average difference was Ϫ0.22 MJ/d, with an SD ⌬ of 1.57 MJ/d and limits of agreement from Ϫ3.37 to 2.93. The average difference between measured resting energy expenditure and the Talbot prediction with a stress factor of 1.5 was Ϫ0.23 MJ/d, with an SD ⌬ of 1.36 MJ/d and limits of agreement from Ϫ2.95 to 2.48; for a stress factor of 1.3, it was 0.42 MJ/d, with an SD ⌬ of 1.24 MJ/d and limits of agreement from Ϫ2.04 to 2.92. These limits of agreement indicate large differences in energy expenditure between the measured value and the prediction estimated for some patients. Therefore, neither the Harris-Benedict nor the Talbot method will predict resting energy expenditure with acceptable precision for clinical use. Indirect calorimetry appears to be the only useful way of determining resting energy expenditure in these patients.

New Concepts in Patient Monitoring System

Biomedical Engineering II, 1983

Publisher Summary The introduction of “computer-on-a-chip” concept was the event that signaled a ... more Publisher Summary The introduction of “computer-on-a-chip” concept was the event that signaled a breakthrough in the application of biomedical technology. Its small size, reliability, flexibility, low power requirements, and cost made it attractive for consideration in a variety of tasks, and even with present-day budget constraints. Instruments have become microcomputer-controlled, or microcomputer based. This chapter presents a system where an algorithm was added to the processing functions, after the initial acquisition of the system, by field replacement of a programmable chip. Implementing a comparable change in a hardware driven instrument would probably require sufficient electromechanical redesign so as to warrant release of a new instrument model. Preprogrammed signal processing algorithms can include, for example, adaptive digital filtering techniques that would be less attractive in an analog instrumentation. The system ECG processing algorithm includes a task that branches upon the detection of an artificial pacemaker during the patient's cardiac activity. To increase system efficiency, the tasks are allocated to separate microprocessors.

Getting Started with IEC 80001

Getting Started with IEC 80001