Determinants of cesarean delivery, a population-based study in the Emilia Romagna Region

Cesarean Delivery (CD) rates are rising in many parts of the world. In order to define strategies to reduce them, it is important to explore the role of clinical and organizational factors. This thesis has the objective to describe the contemporary CD practice and study clinical and organizational variables as determinants of CD in all women who gave birth between 2005 and June 2010 in the Emilia Romagna region (Italy). All hospital discharge abstracts of women who delivered between 2005 and mid 2010 in the region were selected and linked with birth certificates. In addition to descriptive statistics, in order to study the role of clinical and organizational variables (teaching or non-teaching hospital, birth volumes, time and day of delivery) multilevel Poisson regression models and a classification tree were used. A substantial inter-hospital variability in CD rate was found, and this was only partially explained by the considered variables. The most important risk factors of CD were: previous CD (RR 4,95; 95%CI: 4,85-5,05), cord prolapse (RR 3,51; 95% CI:2,96-4,16), and malposition/malpresentation (RR 2,72; 95%CI: 2,66-2,77). Delivery between 7 pm and 7 am and during non working days protect against CD in all subgroups including those with a small number of elective CDs while delivery at a teaching hospital and birth volumes were not statistically significant risk factors. The classification tree shows that previous CD and malposition/malpresentation are the most important variables discriminating between high and low risk of CD. These results indicate that other not considered factors might explain CD variability and do not provide clear evidence that small hospitals have a poor performance in terms of CD rate. Some strategies to reduce CD could be found by focusing on the differences in delivery practice between day and night and between working and no-working day deliveries.

Hybrid ground-aerial mesh networks for IoT monitoring applications: network design and software platform development

The Internet of Things (IoT) has grown rapidly in recent years, leading to an increased need for efficient and secure communication between connected devices. Wireless Sensor Networks (WSNs) are composed of small, low-power devices that are capable of sensing and exchanging data, and are often used in IoT applications. In addition, Mesh WSNs involve intermediate nodes forwarding data to ensure more robust communication. The integration of Unmanned Aerial Vehicles (UAVs) in Mesh WSNs has emerged as a promising solution for increasing the effectiveness of data collection, as UAVs can act as mobile relays, providing extended communication range and reducing energy consumption. However, the integration of UAVs and Mesh WSNs still poses new challenges, such as the design of efficient control and communication strategies. This thesis explores the networking capabilities of WSNs and investigates how the integration of UAVs can enhance their performance. The research focuses on three main objectives: (1) Ground Wireless Mesh Sensor Networks, (2) Aerial Wireless Mesh Sensor Networks, and (3) Ground/Aerial WMSN integration. For the first objective, we investigate the use of the Bluetooth Mesh standard for IoT monitoring in different environments. The second objective focuses on deploying aerial nodes to maximize data collection effectiveness and QoS of UAV-to-UAV links while maintaining the aerial mesh connectivity. The third objective investigates hybrid WMSN scenarios with air-to-ground communication links. One of the main contribution of the thesis consists in the design and implementation of a software framework called "Uhura", which enables the creation of Hybrid Wireless Mesh Sensor Networks and abstracts and handles multiple M2M communication stacks on both ground and aerial links. The operations of Uhura have been validated through simulations and small-scale testbeds involving ground and aerial devices.

Advancing digital healthcare research and machine learning-aided knowledge extraction amidst the COVID-19 pandemic

The rapid progression of biomedical research coupled with the explosion of scientific literature has generated an exigent need for efficient and reliable systems of knowledge extraction. This dissertation contends with this challenge through a concentrated investigation of digital health, Artificial Intelligence, and specifically Machine Learning and Natural Language Processing's (NLP) potential to expedite systematic literature reviews and refine the knowledge extraction process. The surge of COVID-19 complicated the efforts of scientists, policymakers, and medical professionals in identifying pertinent articles and assessing their scientific validity. This thesis presents a substantial solution in the form of the COKE Project, an initiative that interlaces machine reading with the rigorous protocols of Evidence-Based Medicine to streamline knowledge extraction. In the framework of the COKE (“COVID-19 Knowledge Extraction framework for next-generation discovery science”) Project, this thesis aims to underscore the capacity of machine reading to create knowledge graphs from scientific texts. The project is remarkable for its innovative use of NLP techniques such as a BERT + bi-LSTM language model. This combination is employed to detect and categorize elements within medical abstracts, thereby enhancing the systematic literature review process. The COKE project's outcomes show that NLP, when used in a judiciously structured manner, can significantly reduce the time and effort required to produce medical guidelines. These findings are particularly salient during times of medical emergency, like the COVID-19 pandemic, when quick and accurate research results are critical.