Guardian System Research Articles

Utility of the AngelMed Guardian System in myocardial bridging: a case report

BackgroundMyocardial bridging (MB) is a known congenital anomaly in which a segment of the coronary artery transverses from the epicardium through the myocardium. MB may clinically manifest as recurrent angina, acute coronary syndrome, ventricular dysrhythmia, and even sudden cardiac death. On electrocardiogram (EKG), MB can present with findings consistent with significant ST-segment changes. The AngelMed Guardian System (the Guardian device) was developed in an effort to optimize the time from the onset of myocardial ischemia to intervention. The device analyzes myocardial electrical changes and alerts the patient to seek emergent medical evaluation if an acute ST-segment deviation is detected. We describe the first documented case of the Guardian device detecting acute ST-segment changes secondary to myocardial bridging.Case PresentationA 50-year-old male, with a history of percutaneous coronary intervention of the proximal left anterior descending (LAD) artery, presented to his cardiologist’s office with reports of recurrent, atypical chest pain. The Guardian device was implanted. One month after implantation, the patient experienced chest pain and was alerted by the Guardian device to seek emergent medical evaluation. Initial EKG and high-sensitivity troponins were negative for acute ischemia. Guardian device interrogation revealed significant ST depressions, encouraging further ischemic evaluation. The exercise myocardial perfusion imaging revealed an apical reversible defect. Left heart catheterization revealed a large segment of mid-LAD MB with the patient’s previous LAD stent noted to be widely patent along with no evidence of new obstructive coronary disease. Following the identification of the MB, medication regimen adjusted and the patient denied recurrence of chest pain or Guardian alerts.ConclusionsWe describe the first documented case of the Guardian device detecting acute ST-segment changes that were secondary to myocardial bridging. The Guardian device appropriately documented an ischemic event not appreciated with initial EKG or troponin testing. With the assistance of the Guardian device, we were able to rapidly identify MB as the cause for the ischemic EKG changes and subsequent abnormal stress test, optimize medical management, and prevent recurrent atypical chest pain along with office and hospital visits.

The GUARDIAN system-a GNSS upper atmospheric real-time disaster information and alert network

We introduce GUARDIAN, a near-real-time (NRT) ionospheric monitoring software for natural hazards warning. GUARDIAN’s ultimate goal is to use NRT total electronic content (TEC) time series to (1) allow users to explore ionospheric TEC perturbations due to natural and anthropogenic events on earth, (2) automatically detect those perturbations, and (3) characterize potential natural hazards. The main goal of GUARDIAN is to provide an augmentation to existing natural hazards early warning systems (EWS). This contribution focuses mainly on objective (1): collecting GNSS measurements in NRT, computing TEC time series, and displaying them on a public website (https://guardian.jpl.nasa.gov). We validate the time series obtained in NRT using well-established post-processing methods. Furthermore, we present an inverse modeling proof of concept to obtain tsunami wave parameters from TEC time series, contributing significantly to objective (3). Note that objectives (2) and (3) are only introduced here as parts of the general architecture, and are not currently operational. In its current implementation, the GUARDIAN system uses more than 70 GNSS ground stations distributed around the Pacific Ring of Fire, and monitoring four GNSS constellations (GPS, Galileo, BDS, and GLONASS). As of today, and to the best of our knowledge, GUARDIAN is the only software available and capable of providing multi-GNSS NRT TEC time series over the Pacific region to the general public and scientific community.

The social robot companion to support homecare nurses: The guardian study protocol

IntroductionThe reduction of the older people's self-sufficiency and the increase in the need for help in daily activities has a significant impact on the person and their caregivers. The primary objective of the GUARDIAN project is to enable the older people to live as long as possible at home, by means of the GUARDIAN socio-technical platform. Methodsand Analysis: The GUARDIAN platform consists of two connected apps: one dedicated to the caregiver (Caregiver App) and one dedicated to the older people (Senior App), plus a robot (Misty II), to provide coaching in an engaging modality. The study is designed as a technical feasibility pilot to test the GUARDIAN system on a group of older people. DiscussionsThe proposed solution reflects the real wants and needs of the older people person, increasing the acceptability of the system. In addition, the GUARDIAN project has the potential to have distinguished two phases of testing, so that changes can be made to the platform between the first and second phases, using data, both qualitative and quantitative, collected after the first phase. Ethics and disseminationThe study was approved by the Ethic Committee of the IRCCS INRCA. It was recorded in ClinicalTrials.gov on the number NCT05284292.

A framework of safety analysis with temporal feature based on MBSA and case study for ACC system

The safety of automotive Adaptive Cruise Control (ACC) system is of great significance to prevent fatigue driving, improve driving comfort, reduce accident rate and promote the development of intelligent transportation and autonomous driving technology. However, the current safety analysis of ACC lacks consideration of the temporal dynamic property, so it is necessary to establish a set of safety analysis methods to consider the temporal characteristics. This paper proposes a new safety analysis method based on MBSA framework and introduces temporal features. Altarica3.0 is a high-level modeling language for safety analysis, and its basic mathematical form is Guardian Transformation System (GTS). In this paper, we outline an analysis approach that converts failure behavioral models (GTS) to temporal fault trees (TFTs), which can be analyzed using Pandora a recent technique for introducing temporal logic to fault trees. However, like classical fault tree analysis, TFT analysis requires a lot of manual effort, which makes it time consuming and expensive. In order to improve the safety of the system, the proposal extends Bayesian Networks with Pandora and results to dependability analysis with temporal relationships to provide more reliable basis for safety design. As a typical case study, the safety analysis method proposed in this paper is applied to the safety analysis of adaptive cruise system, and the results show the effectiveness of the proposed method. Furthermore, it also provides new technologies for the automation and intelligence of safety analysis for smart internet of vehicle.

Tauhid and Taqwa: The Soul in the COSO-ERM Framework -An Imaginary Research Dialogue-

This research is an imaginary dialogue between two internal auditors of a state university. They are called as a religious senior auditor and a junior auditor. The imaginary dialogue used spirituality in order to avoid misunderstanding and heartache of each other. Both of them discuss current issues in regard to internal control as a soul and foundation to achieve the organization's objectives. This research is to discuss the concept of internal control built by the Committee of Sponsoring Organizations of the Treadway Commission (COSO), whether is it enough to be the guardian system or is there missing elements that should be discovered? They will use the COSO-ERM (Entreprises Risk Management) as the modification of COSO, as the internal control world considers risk management is the key to prevent an organization from failure nowadays. Finally, this research offer a deconstruction of the COSO-ERM framework to become The Tauhid Taqwa-COSO-ERM Framework with Tauhid and Taqwa as the most foundation of all things in the framework especially for the human as the operator in all level.Keywords: tauhid, taqwa, COSO-ERM, and internal control

The AngelMed Guardian® System in the Detection of Coronary Artery Occlusion: Current Perspectives.

Total ischemic time, which specifies the time from the onset of chest pain to initiation of reperfusion during percutaneous coronary intervention, consists of two intervals: symptom to door time and door to balloon time. A door to balloon time of 90 mins or less has become a quality-of-care metric in the management of ST elevation myocardial infarction (STEMI). While national efforts made by the American College of Cardiology (ACC) and American Heart Association (AHA) have curtailed in-hospital door to balloon time over the years, a reduction in pre-hospital symptoms to door time presents a challenge in modern interventional Cardiology. Early and complete revascularization has been associated with improved clinical outcomes in MI and strategies that may help reduce symptom to door time, and thus the total ischemic time, are crucial. Rapidly evolving ST-segment changes commonly develop prior to ischemia-related symptom onset, and are detectable even in patients with clinically unrecognized silent MIs. Therefore, a highly intelligent ischemia detection system that alerts patients of ST segment deviation may allow for rapid identification of acute coronary occlusion. The AngelMed Guardian® System is a cardiac activity monitoring and alerting system designed for rapid identification of intracardiac ST-segment changes among patients at a high risk for recurrent ACS events. This article reviews the clinical studies evaluating the design, safety and efficacy of the AngelMed Guardian System and discusses the clinical implications of the device.

Flight Guardian: Autonomous Flight Safety Improvement by Monitoring Aircraft Cockpit Instruments

During in-flight emergencies, a pilot’s workload increases significantly, and it is often during this period of increased stress that human errors occur that consequently diminish the flight safety. Research studies indicate that many plane crashes can be attributed to ineffective cockpit instrument monitoring by the pilot. This paper entails the development of Flight Guardian¶ system being first of its kind that aims to provide efficient flight-deck awareness to improve flight safety while assisting the pilot in abnormal situations. The system is intended to be used in older aircraft that cannot easily or cost effectively be modified with modern digital avionic systems. One of the important features of the Flight Guardian system is being not physically connected to the aircraft, which avoids any impact on airworthiness or the need for recertification. For the first time, a composite of techniques including video analysis, knowledge representation, and machine belief representations are combined to build a novel flight-deck warning system. The prototype system is tested in both simulation-based laboratory and real flight environments under the guidance of expert pilots. The overall system performance is evaluated using statistical analysis of experimental results that proved the robustness of the proposed methodology in terms of automated warning generation in hazardous situations.

Relationship Between Baseline Influenza-like Illness Rates And Healthcare Settings

ObjectiveTo examine the baseline influenza-like illness (ILI) rates in theemergency departments (ED) of a large academic medical center(AMC), community hospital (CH), and neighboring adult andpediatric primary care clinics.IntroductionThe primary goal of syndromic surveillance is early recognitionof disease trends, in order to identify and control infectious diseaseoutbreaks, such as influenza. For surveillance of influenza-like illness(ILI), public health departments receive data from multiple sourceswith varying degrees of patient acuity, including outpatient clinicsand emergency departments. However, the lack of standardization ofthese data sources may lead to varying baseline levels of ILI activitywithin a local area.MethodsGeographic Utilization of Artificial Intelligence in Real-Timefor Disease Identification and Alert Notification (GUARDIAN) – asyndromic surveillance program – was used to automate ILI detectionusing free text chief complaint/reason for visit fields and vital signsfor a large AMC - ED, CH - ED, and neighboring outpatient clinicsduring the summer (June 15, 2016 to August 18, 2016) in order tocreate a baseline. The GUARDIAN system defined ILI as fever(temperature≥100°F) and cough and/or sore throat. Descriptiveanalysis of the observed ILI rates along with bivariate ANOVA withpost hoc Bonferroni and t-test were utilized to examine the differencewithin the settings.ResultsThe average ILI rate for EDs is higher than the clinics by at least0.39%. The CH- ED had 4.23% baseline ILI rate as compared to1.35% for AMC-ED. While the AMC – Clinics have 0.96% baselineILI rate as compared to 0.25% for CH – Clinics. The CH- ED andAMC – Clinics represented higher variations. Based on bivariate test,CH – ED was significantly different than AMC – ED, AMC - Clinics,and CH – Clinics (F= 10.58, df = 1238, p<0.05). For the AMC –Clinics, the average ILI rate for clinics providing services to adultpatients was 0.66% (SD: 4.5%) as compared to 2.03% (SD: 10.81%)for pediatric clinics, which was not statistically significant.ConclusionsThe CH - ED has higher baseline ILI rates compared to othersettings, as well as the CDC Region 5’s baseline (1.9% for 2015-2016). Based on previous studies1, this is likely due to providers’use of chief complaint free text fields. Thus, the CH – ED will havehigher thresholds for widespread ILI activity. In addition, differencesin baseline ILI rates between AMC - ED, AMC - Clinics, and CH -Clinics may result in different thresholds for widespread ILI activity(i.e., Average + 3 Standard Deviations). The CH – ED and AMC –Clinics had higher baseline standard deviations, indicting variationsin underlying patient populations. In addition, pediatric clinics havehigher baseline ILI activity but also higher variations, indicating theunique characteristics of pediatric patients. Thus, due to the abovefindings, there is a need to closely monitor the ILI rates at varioushealthcare sites for both timing of onset, as well as the intensity ofILI activity.

The AngelMed Guardian system: Is there a role for implantable devices for early detection of coronary artery occlusion?

The AngelMed Guardian System is an implantable device similar to a single chamber pacemaker that continuously monitors the intracardiac electrogram for evidence of ST segment shift indicating acute coronary artery occlusion. The system aims to reduce time to presentation by alerting patients to present to a medical facility whether symptoms are present or not. In March 2016, the US Food and Drug Administration (FDA) assembled a meeting of the Circulatory System Devices Panel to review the results of the AngelMed for Early Recognition and Treatment of STEMI (ALERTS) pivotal trial and the accompanying premarket approval (PMA) application for regulatory approval of the AngelMed Guardian System in the US. In this review, we examine the ALERTS trial methodology and results, and describe the FDA panel's deliberations and recommendations.

Overview of the 2016 US Food and Drug Administration Circulatory System Devices Panel Meeting on the AngelMed Guardian System.

On March 16, 2016, the US Food and Drug Administration (FDA) convened a meeting of the Circulatory System Devices Panel to consider a premarket approval application for the AngelMed Guardian System based on the results of the pivotal ALERTS trial (AngelMed for Early Recognition and Treatment of STEMI) (URL: http://www.clinicaltrials.gov. Unique identifier: NCT00781118). The system comprises an implantable device similar to a single-chamber pacemaker, an external device that the patient carries, and a physician console. The device analyzes ST-segment shift through a single active-fixation lead in the right ventricular apex. If ST shift is identified, then the implantable device vibrates and the external device flashes and sounds an auditory alarm. More than 1 in 3 acute myocardial infarctions occur without chest pain, most commonly in women, diabetic patients, and the elderly. ST shift occurs rapidly in humans following coronary balloon occlusion.1 The AngelMed Guardian aims to reduce time to presentation by alerting the patient to ST shift even in the absence of symptoms. The ALERTS trial tested the safety and effectiveness of the Guardian System. A Bayesian adaptive design was used to adjust sample size based on interim treatment effect. The trial enrolled high-risk patients with a history of coronary artery disease (97% had previous revascularization). The trial was stopped early because of concerns that the predictive model did not accurately account for new Q waves. Nine hundred ten patients had the Guardian implanted (451 in the treatment arm versus 456 in the control arm with the device deactivated). Study …

The Examination on the Stone Stele Associated with Tomb Guardian System of Koguryo

The Examination on the Stone Stele Associated with Tomb Guardian System of Koguryo

Higher glucose concentrations following protein- and fat-rich meals - the Tuebingen Grill Study: a pilot study in adolescents with type 1 diabetes.

Traditionally insulin dosage is focused on the carbohydrate amount of meals. We investigated the influence of a fat- and protein-rich meal in the evening on glucose concentration over night in adolescents with type 1 diabetes. Fifteen patients, mean age 16.8 [standard deviation (SD) 2.9] yr participated in the study. Mean glycated hemoglobin (HbA1c) was 6.9 (range: 6.0-8.9) %. On two consecutive days the patients received a standard meal (SM) and a fat-protein-rich evening meal (FPRM). The carbohydrate amount remained identical and insulin was adjusted to this carbohydrate amount with the individual carbohydrate bolus. Glucose was measured continuously over night with the Enlite sensor and the Guardian system (Medtronic) during the following 12 h after the meal. Glucose area under the curve (AUC) for SM was 1400 (SD 580) mg/dL/12 h and for FPRM 1968 (SD 394) mg/dL/12 h (p < 0.05). There was a significant difference in the AUC between 4 and 12 h after the meal. Maximal AUC difference was 6 h after the meal. Glucose concentration in the morning (12 h after the meal) differed: 91 (SD 34) mg/dL after SM and 153 (SD 60) mg/dL after FPRM (p < 0.05). For SM 31% of glucose level were <80 mg/dL and 24% >150 mg/dL, for FPRM it was 3 and 48%. Twelve hours after a FPRM glucose concentration is significantly higher. Dietary counseling should include the effect of protein and fat on glucose levels in adolescents with type 1 diabetes. The data indicate clearly a need for additional insulin for fat-protein-rich meals.

A Study on the Education and Training Conditions of Adult Guardian System in Korea

A Study on the Education and Training Conditions of Adult Guardian System in Korea

An Exploratory Analysis to the Practical Tasks for Community Welfare According to the Enforcement of the Adult Guardian System

성년후견제는 재산관리 뿐만 아니라 신상보호와 관련된 다양한 영역에서 의사결정지원이 필요한 장애인 및 치매노인 등에게 일상생활 속에서 자기결정권을 가지고 지역사회의 한 구성원으로 살아가는데 불이익을 받지 않도록 의사결정능력을 지원하는 제도이다. 이러한 성년후견제는 본래 시민사회 관계를 규율하는 민법상의 제도를 기초로 하고 있지만 또한 소외계층에 대한 인권 보장적 성격이 강한 사회복지제도이기도 하다. 본 연구는 우리나라의 성년후견제도 시행과 관련하여 지역사회복지의 실천과제에 대해 탐구하였으며, 국내외 문헌조사를 주로 사용하였다.BR 성년후견제도의 시행과 제도 정착을 위한 지역사회복지내의 서비스 전달체계 및 지역사회복지 실천과제에 대한 주요 결과는 다음과 같다. 첫째, 지역내 개별 주체들은 성년후 견제 운영과 관련된 역할분담을 충실히 수행할 필요가 있다. 이를 위해 대표성을 가진 지역내 네트워크를 구축할 필요가 있다. 둘째, 지역 상황에 근거한 제도운영이 필요하다. 관련 서비스와 프로그램은 지역단위에 맞게 설계되고, 지역내 수요자 특성을 고려하여야 한다. 이를 위해 지역관련 기초 조사나 연구가 필요하다. 셋째, 지방자치단체는 전반적인 지원체계를 정비하고, 성년후견제의 원활한 지원을 위하여 관련 전문위원회 운영, 조례제정 등 기본적인 사항들을 제도적으로 마련할 필요가 있다. 넷째, 지역내 가정법원과의 연계 구조를 구축할 필요가 있다. 다섯째, 지역내 성년후견지원센터의 설립을 통한 체계적인 운영이 필요하다. 여섯째, 지역내 사회복지기관과 성년후견관련 전문기관 등 민간기관의 적극적인 참여가 필요하다. 일곱째, 지역의 탈시설 정책과 연계될 필요가 있다. 여덟째, 성년후견제 실시를 계기로 기존의 낙후된 관련 복지정책 전반을 보완할 필요가 있다. 이는 성년후견제의 실속 있는 운영을 위해서도 필요한 부분이다.

정보화시대에서 발달장애인의 성년후견제도에 관한 연구

본 연구는 급격히 변화되고 있는 정보화시대에서, 성년후견제도가 발달장애인의 복지향상에 어떠한 의의를 함의하고 있는지 그 의미를 분석함을 목적으로 한다. 이를 통해 성년후견제도의 주요한 집단인 발달장애인에 대한 성년후견제도의 개선방안을 모색하였다. 발달장애인의 입장에서 현행 성년후견제도는 자립생활과 사회통합에 기여할 수 있는 복지제도가 될 수 있어야 한다. 또한, 인터넷을 통한 가상공간에서 제도개선을 위한 정보교류와 다양한 커뮤니티 형성이 이루어져야 한다. This research intends to analyze the implications of current adult guidance system from an angle of people with developmental disabilities in an sudden changed information age. Through it, this research intends to seek improvement of adult guardian system for people with developmental disabilities, a main group of the system, from an angle different from the aged. It focuses on significance and improvement for the significance of adult guardian system for people with developmental disabilities, which are weak for self-decision. Furthermore, for the improvements, this system should be able to be information exchange and communities through the using internet in the cyber space.

「『高齢者の終末期の医療およびケア』に関する日本老年医学会の『立場表明』（倫理委員会改訂案）」に対する日本老年医学会代議員等の意識調査研究

To clarify the opinions of members of the Japan Geriatric Society regarding the revised version of their Position Statement on terminal medicine and care in elderly patients. A self-report questionnaire was sent to special honorary members, emeritus academic staff, and officers and delegates of the Japan Geriatrics Society (789 people). The questions were: 1) Do you agree with the Position Statement as revised by the Ethics Committee of the Japan Geriatric Society or not? 2) Do you have any ideas about any specific item and its' content or necessary revisions and if so, what are they? 3) Are there any headings or items that should be added to the Q&A section and if so, what are they? The response rate was 28.5% (225/789). Of these, 91.6% agreed with the revised version of the Position Statement. More than 80% of respondents had no suggested revisions. Suggested items that should be added to the Q&A were: advanced directives or advanced care plans, legal interpretation on the withholding of life-support treatments including hemodialysis, the establishment of a guardian system, and legal interpretation of the decisions made by the Ethics Committee. Although most respondents agreed with the revised version of the Position Statement, some issues remain to be discussed, including the relationship of patient autonomy with the optimal benefits for those in terminal-stage disease, the decision-making systems regarding the introduction and withholding of life-support treatments such as artificial nutrition, artificial ventilation, and hemodialysis.

A Light RSSI-Based Three Dimensions Location Estimation Algorithm for Indoor ZigBee Network

Received signal strength indication (RSSI) is one of the primary location techniques, which has been popularly used in ZigBee wireless sensor network. In this paper, the authors suggest to use RSSI-based technique to design a three dimensions location and finally realize valuables guardian system within an intelligent environment supplied with indoor ZigBee network. Several mobile nodes can be freely attached to the valuables and the movement of the nodes will be monitored by the system in period. Hierarchical alarm mechanism could be issued when some abnormal movements have been identified according to some pre-defined rules. The misstatement rate is low in the experiment.

A Study on Improvement of MOJ Legislation for Adult Guardian System

A Study on Improvement of MOJ Legislation for Adult Guardian System

P02-77 - Psychosocial and personality conditions of juvenile criminal thinking style

BackgroundThe issues of my research study concern psychosocial and personality conditioning of criminal thinking styles of juveniles.The objective of my research study is to distinguish and characterize profiles of criminal thinking styles of juvenile boys and girls who committed a criminal offence and to define psychosocial (restricting to the family environment - a guardian system) and personality factors conditioning a criminal thinking style of juveniles.MethodFor the purpose of the research following methods have been used: PICTS by G. Walters - has been adapted into polish circumstances, Values Scale (Rokeach), Davis Empathy Scale, The Tennessee Self-Concept Scale (TSCS) by Fitts, Skala Postaw by Plpoa, KBPK by Kurzyp-Wojnarska.Research tasksIn the analysed problem the following research tasks are involved:·Singling out of juvenile criminal thinking styles·determining the criminal predicators in criminal thinking styles·establishing predicators of criminal thinking styles, defining factors determining criminal thinking style of juveniles (a group of explanatory variables include: thinking styles of parents (guardians), parents’ attitude towards a child, a value system of parents, personality variables of a juvenile, i.e. self-esteem, empathy level (level of emphatic understanding), a sense of control and a social competence level).showing (presenting) constitutive differences and similarities In terms of criminal thinking styles between the group of minors and their parents (guardian)·establishing the differences and similarities in terms of cognitive functioning (thinking styles) of the juveniles due to the criminal act.

Real-time control systems secured communication

As demands on privacy, personal data and in general secure and responsible dealing with confidential personal information are growing, the need for their protection grows as well. When confidential data are being transported, there is a high risk of their stole and misuse or complete loss. That's why a question of secure communication is one of the most actual topics of a present day. It's not just information technologies problem, but since embedded and automation devices are more and more sophisticated, able to use for example internet technologies, this question also concerns the area of automation and control systems. Especially in complex distributed control and measurement systems that supports remote control, internet visualization, wireless transfers or remote data acquisition, it is the primary goal to ensure the most secure and reliable communication. This work deals with securing the communication of embedded systems connected over public networks and internet. To fulfill that, PKI technologies are used. Benefits of secured communication are employed in Guardian system, patient monitoring platform developed at Technical University of Ostrava.