Variation in Current Management of Term and Late-Preterm Neonates at Risk for Early-Onset Sepsis "An International Survey and Review of Guidelines"

BACKGROUND Uncertainty about the presence of infection results in unnecessary and prolonged empiric antibiotic treatment of newborns at risk for early-onset sepsis (EOS). This study evaluates the impact of this uncertainty on the diversity in management. METHODS A web-based survey with questions addressing management of infection risk-adjusted scenarios was performed in Europe, North America, and Australia. Published national guidelines (n=5) were reviewed and compared to the results of the survey. RESULTS 439 Clinicians (68% were neonatologists) from 16 countries completed the survey. In the low-risk scenario, 29% would start antibiotic therapy and 26% would not, both groups without laboratory investigations; 45% would start if laboratory markers were abnormal. In the high-risk scenario, 99% would start antibiotic therapy. In the low-risk scenario, 89% would discontinue antibiotic therapy before 72 hours. In the high-risk scenario, 35% would discontinue therapy before 72 hours, 56% would continue therapy for five to seven days, and 9% for more than 7 days. Laboratory investigations were used in 31% of scenarios for the decision to start, and in 72% for the decision to discontinue antibiotic treatment. National guidelines differ considerably regarding the decision to start in low-risk and regarding the decision to continue therapy in higher risk situations. CONCLUSIONS There is a broad diversity of clinical practice in management of EOS and a lack of agreement between current guidelines. The results of the survey reflect the diversity of national guidelines. Prospective studies regarding management of neonates at risk of EOS with safety endpoints are needed.

Development of a standard sign-out procedure for clinicians in a pediatric intensive care unit

Background: Poor communication among health care providers is cited as the most common cause of sentinel events involving patients. Sign-out of patient data at the change of clinician shifts is a component of communication that is especially vulnerable to errors. Sign-outs are particularly extensive and complex in intensive care units (ICUs). There is a paucity of validated tools to assess ICU sign-outs. ^ Objective: To design a valid and reliable survey tool to assess the perceptions of Pediatric ICU (PICU) clinicians about sign-out. ^ Design: Cross-sectional, web-based survey ^ Setting: Academic hospital, 31-bed PICU ^ Subjects: Attending faculty, fellows, nurse practitioners and physician assistants. ^ Interventions: A survey was designed with input from a focus group and administered to PICU clinicians. Test-retest reliability, internal consistency and validity of the survey tool were assessed. ^ Measurements and Main Results: Forty-eight PICU clinicians agreed to participate. We had 42(88%) and 40(83%) responses in the test and retest phases. The mean scores for the ten survey items ranged from 2.79 to 3.67 on a five point Likert scale with no significant test-retest difference and a Pearson correlation between pre and post answers of 0.65. The survey item scores showed internal consistency with a Cronbach's Alpha of 0.85. Exploratory factor analysis revealed three constructs: efficacy of sign-out process, recipient satisfaction and content applicability. Seventy eight % clinicians affirmed the need for improvement of the sign-out process and 83% confirmed the need for face- to-face verbal sign-out. A system-based sign-out format was favored by fellows and advanced level practitioners while attendings preferred a problem-based format (p=0.003). ^ Conclusions: We developed a valid and reliable survey to assess clinician perceptions about the ICU sign-out process. These results can be used to design a verbal template to improve and standardize the sign-out process.^

The Need for School-Based Teen Dating Violence Prevention

Schools have several competing demands, and often suffer from inefficient access to needed resources. Thus, the addition of any program into an already overtaxed school system must be met with convincing evidence that 1) a need or problem exists and is relevant to the education of students, 2) the problem is amenable to change, and 3) addressing the problem is in the best interest of educators and students. The purpose of the present paper is to present a case for inclusion of teen dating violence prevention programs in middle and high schools. We also discuss a recent survey of 219 employees of a suburban school district in southeast Texas. Specifically, we examined their perceived need for and appropriateness of a school-based dating violence prevention program. The anonymous internet-based survey revealed that a majority of participants believed that teen dating violence was a problem, 19% reported having observed an instance of teen dating violence, and 82% believed school to be an appropriate outlet for the implementation of a dating violence prevention program.

Implicaciones de la accesibilidad configuracional en la movilidad peatonal. El caso de Madrid = The implications of configurational accessibility in pedestrian mobility. The case of Madrid

- Resumen La hipótesis que anima esta tesis doctoral es que algunas de las características del entorno urbano, en particular las que describen la accesibilidad de su red de espacio público, podrían estar relacionadas con la proporción de viajes a pie o reparto modal, que tiene cada zona o barrio de Madrid. Uno de los puntos de partida de dicha hipótesis que el entorno urbano tiene una mayor influencia sobre los viaje a pie que en sobre otros modos de transporte, por ejemplo que en los viajes de bicicleta o en transporte público; y es que parece razonable suponer que estos últimos van a estar más condicionadas por ejemplo por la disponibilidad de vías ciclistas, en el primer caso, o por la existencia de un servicio fiable y de calidad, en el segundo. Otra de las motivaciones del trabajo es que la investigación en este campo de la accesibilidad del espacio público, en concreto la denominada “Space Syntax”, ha probado en repetidas ocasiones la influencia de la red de espacio público en cómo se distribuye la intensidad del tráfico peatonal por la trama urbana, pero no se han encontrado referencias de la influencia de dicho elemento sobre el reparto modal. De acuerdo con la hipótesis y con otros trabajos anteriores se propone una metodología basada en el análisis empírico y cuantitativo. Su objetivo es comprobar si la red de espacio público, independientemente de otras variables como los usos del suelo, incluso de las variables de ajenas entorno no construido, como las socioeconómicas, está o no relacionada estadísticamente con la proporción de peatones viajes en las zonas urbanas. Las técnicas estadísticas se utilizan para comprobar sistemáticamente la asociación de las variables del entorno urbano, denominadas variables independientes, con el porcentaje de viajes a pie, la variable dependiente. En términos generales, la metodología es similar a la usada en otros trabajos en este campo como los de CERVERÓ y KOCKLEMAN (1997), CERVERÓ y DUNCAN (2003), o para los que se utilizan principalmente en la revisión general de TRB (2005) o, más recientemente, en ZEGRAS (2006) o CHATMAN (2009). Otras opciones metodológicas, como los métodos de preferencias declaradas (ver LOUVIERE, HENSHER y SWAIT, 2000) o el análisis basado en agentes (PENN & TURNER, 2004) fueron descartados, debido a una serie de razones, demasiado extensas para ser descritas aquí. El caso de estudio utilizado es la zona metropolitana de Madrid, abarcándola hasta la M-50, es decir en su mayor parte, con un tamaño aproximado de 31x34 Km y una población de 4.132.820 habitantes (aproximadamente el 80% de la población de la región). Las principales fuentes de datos son la Encuesta Domiciliaria de Movilidad de 2004 (EDM04), del Consorcio Regional de Transportes de Madrid que es la última disponible (muestra: > 35.000 familias,> 95.000 personas), y un modelo espacial del área metropolitana, integrando el modelo para calcular los índices de Space Syntax y un Sistema de Información Geográfica (SIG). La unidad de análisis, en este caso las unidades espaciales, son las zonas de transporte (con una población media de 7.063 personas) y los barrios (con una población media de 26.466 personas). Las variables del entorno urbano son claramente el centro del estudio. Un total de 20 índices (de 21) se seleccionan de entre los más relevantes encontrados en la revisión de la producción científica en este campo siendo que, al mismo tiempo, fueran accesibles. Nueve de ellos se utilizan para describir las características de los usos del suelo, mientras que otros once se usan para describir la red de espacios públicos. Estos últimos incluyen las variables de accesibilidad configuracional, que son, como se desprende de su título, el centro del estudio propuesto. La accesibilidad configuracional es un tipo especial de accesibilidad que se basa en la configuración de la trama urbana, según esta fue definida por HILLIER (1996), el autor de referencia dentro de esta línea de investigación de Space Syntax. Además se incluyen otras variables de la red de espacio público más habituales en los estudios de movilidad, y que aquí se denominan características geométricas de los elementos de la red, tales como su longitud, tipo de intersección, conectividad, etc. Por último se incluye además una variable socioeconómica, es decir ajena al entorno urbano, para evaluar la influencia de los factores externos, pues son varios los que pueden tener un impacto en la decisión de caminar (edad, género, nivel de estudios, ingresos, tasa de motorización, etc.). La asociación entre las variables se han establecido usando análisis de correlación (bivariante) y modelos de análisis multivariante. Las primeras se calculan entre por pares entre cada una de las 21 variables independientes y la dependiente, el porcentaje de viajes a pie. En cuanto a los segundos, se han realizado tres tipos de estudios: modelo multivariante general lineal, modelo multivariante general curvilíneo y análisis discriminante. Todos ellos son capaces de generar modelos de asociación entre diversas variables, pudiéndose de esta manera evaluar con bastante precisión en qué medida cada modelo reproduce el comportamiento de la variable dependiente, y además, el peso o influencia de cada variable en el modelo respecto a las otras. Los resultados fundamentales del estudio se expresan en dos modelos finales alternativos, que demuestran tener una significativa asociación con el porcentaje de viajes a pie (R2 = 0,6789, p <0,0001), al explicar las dos terceras partes de su variabilidad. En ellos, y en general en todo el estudio realizado, se da una influencia constante de tres índices en particular, que quedan como los principales. Dos de ellos, de acuerdo con muchos de los estudios previos, corresponden a la densidad y la mezcla de usos del suelo. Pero lo más novedoso de los resultados obtenidos es que el tercero es una medida de la accesibilidad de la red de espacio público, algo de lo que no había referencias hasta ahora. Pero, ¿cuál es la definición precisa y el peso relativo de cada uno en el modelo, es decir, en la variable independiente? El de mayor peso en la mayor parte de los análisis realizados es el índice de densidad total (n º residentes + n º puestos de trabajo + n º alumnos / Ha). Es decir, una densidad no sólo de población, sino que incluye algunas de las actividades más importantes que pueden darse una zona para generar movilidad a pie. El segundo que mayor peso adquiere, llegando a ser el primero en alguno de los análisis estadísticos efecturados, es el índice de accesibuilidad configuracional denominado integración de radio 5. Se trata de una medida de la accesibilidad de la zona, de su centralidad, a la escala de, más un menor, un distrito o comarca. En cuanto al tercero, obtiene una importancia bastante menor que los anteriores, y es que representa la mezcla de usos. En concreto es una medida del equilibrio entre los comercios especializados de venta al por menor y el número de residentes (n º de tiendas especializadas en alimentación, bebidas y tabaco / n º de habitantes). Por lo tanto, estos resultados confirman buena parte de los de estudios anteriores, especialmente los relativas a los usos del suelo, pero al mismo tiempo, apuntan a que la red de espacio público podría tener una influir mayor de la comprobada hasta ahora en la proporción de peatones sobre el resto de modos de transportes. Las razones de por qué esto puede ser así, se discuten ampliamente en las conclusiones. Finalmente se puede precisar que dicha conclusión principal se refiere a viajes de una sola etapa (no multimodales) que se dan en los barrios y zonas del área metropolitana de Madrid. Por supuesto, esta conclusión tiene en la actualidad, una validez limitada, ya que es el resultado de un solo caso — Abstract The research hypothesis for this Ph.D. Thesis is that some characteristics of the built environment, particularly those describing the accessibility of the public space network, could be associated with the proportion of pedestrians in all trips (modal split), found in the different parts of a city. The underlying idea is that walking trips are more sensitive to built environment than those by other transport modes, such as for example those by bicycle or by public transport, which could be more conditioned by, e.g. infrastructure availability or service frequency and quality. On the other hand, it has to be noted that the previously research on this field, in particular within Space Syntax’s where this study can be referred, have tested similar hypothesis using pedestrian volumes as the dependent variable, but never against modal split. According to such hypothesis, research methodology is based primarily on empirical quantitative analysis, and it is meant to be able to assess whether public space network, no matter other built environment and non-built environment variables, could have a relationship with the proportion of pedestrian trips in urban areas. Statistical techniques are used to check the association of independent variables with the percentage of walking in all trips, the dependent one. Broadly speaking this methodology is similar to that of previous studies in the field such as CERVERO&KOCKLEMAN (1997), CERVERO & DUNCAN (2003), or to those used mainly in the general review of T.R.B. (2005) or, more recently in ZEGRAS (2006) or CHATMAN (2009). Other methodological options such as stated choice methods (see LOUVIERE, HENSHER & SWAIT, 2000) or agent based analysis (PENN & TURNER, 2004), were discarded, due to a number of reasons, too long to be described here. The case study is not the entire Madrid’s metropolitan area, but almost (4.132.820 inhabitants, about 80% of region´s population). Main data sources are the Regional Mobility Home Based Survey 2004 (EDM04), which is the last available (sample: >35.000 families, > 95.000 individuals), and a spatial model of the metropolitan area, developed using Space Syntax and G.I.S. techniques. The analysis unit, in this case spatial units, are both transport zones (mean population = 7.063) and neighborhoods (mean population = 26.466). The variables of the built environment are clearly the core of the study. A total of 20 (out of 21) are selected from among those found in the literature while, at the same time, being accessible. Nine out of them are used to describe land use characteristics while another eleven describe the network of public spaces. Latter ones include configurational accessibility or Space Syntax variables. This is a particular sort of accessibility related with the concept of configuration, by HILLIER (1996), one of the main authors of Space Syntax, But it also include more customary variables used in mobility research to describe the urban design or spatial structure (here public space network), which here are called geometric characteristics of the such as its length, type of intersection, conectivity, density, etc. Finally a single socioeconomic variable was included in order to assess the influence non built environment factors that also may have an impact on walking (age, income, motorization rate, etc.). The association among variables is worked out using bi-variate correlation analysis and multivariate-analysis. Correlations are calculated among the 21 independent variables and the dependent one, the percentage of walking trips. Then, three types of multi-variate studies are run: general linear, curvilinear and discriminant multi-variate analysis. The latter are fully capable of generating complex association models among several variables, assessing quite precisely to what extent each model reproduces the behavior of the dependent variable, and also the weight or influence of each variable in the model. This study’s results show a consistent influence of three particular indexes in the two final alternative models of the multi-variate study (best, R2=0,6789, p<0,0000). Not surprisingly, two of them correspond to density and mix of land uses. But perhaps more interesting is that the third one is a measure of the accessibility of the public space network, a variable less important in the literature up to now. Additional precisions about them and their relative weight could also be of some interest. The density index is not only about population but includes most important activities in an area (nº residents + nº jobs+ nº students/Ha). The configurational index (radius 5 integration) is a measure of the accessibility of the area, i.e. centrality, at the scale of, more a less, a district. Regarding the mix of land uses index, this one is a measure of the balance between retail, in fact local basic retail, and the number of residents (nº of convenience shops / nº of residents). Referring to their weights, configurational index (radius 5 integration) gets the higher standardized coefficient of the final equation. However, in the final equations, there are a higher number of indexes coming from the density or land use mix categories than from public space network enter. Therefore, these findings seem to support part of the field’s knowledge, especially those concerning land uses, but at the same time they seem to bring in the idea that the configuration of the urban grid could have an influence in the proportion of walkers (as a part of total trips on any transport mode) that do single journey trips in the neighborhoods of Madrid, Spain. Of course this conclusion has, at present, a limited validity since it’s the result of a single case. The reasons of why this can be so, are discussed in the last part of the thesis.

Bayesian scene analysis for multi-camera 3D tracking and camera positioning

Los sistemas de seguimiento mono-cámara han demostrado su notable capacidad para el análisis de trajectorias de objectos móviles y para monitorización de escenas de interés; sin embargo, tanto su robustez como sus posibilidades en cuanto a comprensión semántica de la escena están fuertemente limitadas por su naturaleza local y monocular, lo que los hace insuficientes para aplicaciones realistas de videovigilancia. El objetivo de esta tesis es la extensión de las posibilidades de los sistemas de seguimiento de objetos móviles para lograr un mayor grado de robustez y comprensión de la escena. La extensión propuesta se divide en dos direcciones separadas. La primera puede considerarse local, ya que está orientada a la mejora y enriquecimiento de las posiciones estimadas para los objetos móviles observados directamente por las cámaras del sistema; dicha extensión se logra mediante el desarrollo de un sistema multi-cámara de seguimiento 3D, capaz de proporcionar consistentemente las posiciones 3D de múltiples objetos a partir de las observaciones capturadas por un conjunto de sensores calibrados y con campos de visión solapados. La segunda extensión puede considerarse global, dado que su objetivo consiste en proporcionar un contexto global para relacionar las observaciones locales realizadas por una cámara con una escena de mucho mayor tamaño; para ello se propone un sistema automático de localización de cámaras basado en las trayectorias observadas de varios objetos móviles y en un mapa esquemático de la escena global monitorizada. Ambas líneas de investigación se tratan utilizando, como marco común, técnicas de estimación bayesiana: esta elección está justificada por la versatilidad y flexibilidad proporcionada por dicho marco estadístico, que permite la combinación natural de múltiples fuentes de información sobre los parámetros a estimar, así como un tratamiento riguroso de la incertidumbre asociada a las mismas mediante la inclusión de modelos de observación específicamente diseñados. Además, el marco seleccionado abre grandes posibilidades operacionales, puesto que permite la creación de diferentes métodos numéricos adaptados a las necesidades y características específicas de distintos problemas tratados. El sistema de seguimiento 3D con múltiples cámaras propuesto está específicamente diseñado para permitir descripciones esquemáticas de las medidas realizadas individualmente por cada una de las cámaras del sistema: esta elección de diseño, por tanto, no asume ningún algoritmo específico de detección o seguimiento 2D en ninguno de los sensores de la red, y hace que el sistema propuesto sea aplicable a redes reales de vigilancia con capacidades limitadas tanto en términos de procesamiento como de transmision. La combinación robusta de las observaciones capturadas individualmente por las cámaras, ruidosas, incompletas y probablemente contaminadas por falsas detecciones, se basa en un metodo de asociación bayesiana basado en geometría y color: los resultados de dicha asociación permiten el seguimiento 3D de los objetos de la escena mediante el uso de un filtro de partículas. El sistema de fusión de observaciones propuesto tiene, como principales características, una gran precisión en términos de localización 3D de objetos, y una destacable capacidad de recuperación tras eventuales errores debidos a un número insuficiente de datos de entrada. El sistema automático de localización de cámaras se basa en la observación de múltiples objetos móviles y un mapa esquemático de las áreas transitables del entorno monitorizado para inferir la posición absoluta de dicho sensor. Para este propósito, se propone un novedoso marco bayesiano que combina modelos dinámicos inducidos por el mapa en los objetos móviles presentes en la escena con las trayectorias observadas por la cámara, lo que representa un enfoque nunca utilizado en la literatura existente. El sistema de localización se divide en dos sub-tareas diferenciadas, debido a que cada una de estas tareas requiere del diseño de algoritmos específicos de muestreo para explotar en profundidad las características del marco desarrollado: por un lado, análisis de la ambigüedad del caso específicamente tratado y estimación aproximada de la localización de la cámara, y por otro, refinado de la localización de la cámara. El sistema completo, diseñado y probado para el caso específico de localización de cámaras en entornos de tráfico urbano, podría tener aplicación también en otros entornos y sensores de diferentes modalidades tras ciertas adaptaciones. ABSTRACT Mono-camera tracking systems have proved their capabilities for moving object trajectory analysis and scene monitoring, but their robustness and semantic possibilities are strongly limited by their local and monocular nature and are often insufficient for realistic surveillance applications. This thesis is aimed at extending the possibilities of moving object tracking systems to a higher level of scene understanding. The proposed extension comprises two separate directions. The first one is local, since is aimed at enriching the inferred positions of the moving objects within the area of the monitored scene directly covered by the cameras of the system; this task is achieved through the development of a multi-camera system for robust 3D tracking, able to provide 3D tracking information of multiple simultaneous moving objects from the observations reported by a set of calibrated cameras with semi-overlapping fields of view. The second extension is global, as is aimed at providing local observations performed within the field of view of one camera with a global context relating them to a much larger scene; to this end, an automatic camera positioning system relying only on observed object trajectories and a scene map is designed. The two lines of research in this thesis are addressed using Bayesian estimation as a general unifying framework. Its suitability for these two applications is justified by the flexibility and versatility of that stochastic framework, which allows the combination of multiple sources of information about the parameters to estimate in a natural and elegant way, addressing at the same time the uncertainty associated to those sources through the inclusion of models designed to this end. In addition, it opens multiple possibilities for the creation of different numerical methods for achieving satisfactory and efficient practical solutions to each addressed application. The proposed multi-camera 3D tracking method is specifically designed to work on schematic descriptions of the observations performed by each camera of the system: this choice allows the use of unspecific off-the-shelf 2D detection and/or tracking subsystems running independently at each sensor, and makes the proposal suitable for real surveillance networks with moderate computational and transmission capabilities. The robust combination of such noisy, incomplete and possibly unreliable schematic descriptors relies on a Bayesian association method, based on geometry and color, whose results allow the tracking of the targets in the scene with a particle filter. The main features exhibited by the proposal are, first, a remarkable accuracy in terms of target 3D positioning, and second, a great recovery ability after tracking losses due to insufficient input data. The proposed system for visual-based camera self-positioning uses the observations of moving objects and a schematic map of the passable areas of the environment to infer the absolute sensor position. To this end, a new Bayesian framework combining trajectory observations and map-induced dynamic models for moving objects is designed, which represents an approach to camera positioning never addressed before in the literature. This task is divided into two different sub-tasks, setting ambiguity analysis and approximate position estimation, on the one hand, and position refining, on the other, since they require the design of specific sampling algorithms to correctly exploit the discriminative features of the developed framework. This system, designed for camera positioning and demonstrated in urban traffic environments, can also be applied to different environments and sensors of other modalities after certain required adaptations.

Assessment methodology applied to demand measures to change urban mobility behavior

In order to minimize car-based trips, transport planners have been particularly interested in understanding the factors that explain modal choices. Transport modelling literature has been increasingly aware that socioeconomic attributes and quantitative variables are not sufficient to characterize travelers and forecast their travel behavior. Recent studies have also recognized that users’ social interactions and land use patterns influence travel behavior, especially when changes to transport systems are introduced; but links between international and Spanish perspectives are rarely dealt with. The overall objective of the thesis is to develop a stepped methodology that integrate diverse perspectives to evaluate the willingness to change patterns of urban mobility in Madrid, based on four steps: (1st) analysis of causal relationships between both objective and subjective personal variables, and travel behavior to capture pro-car and pro-public transport intentions; (2nd) exploring the potential influence of individual trip characteristics and social influence variables on transport mode choice; (3rd) identifying built environment dimensions on travel behavior; and (4th) exploring the potential influence on transport mode choice of extrinsic characteristics of individual trip using panel data, land use variables using spatial characteristics and social influence variables. The data used for this thesis have been collected from a two panel smartphone-based survey (n=255 and 190 respondents, respectively) carried out in Madrid. Although the steps above are mainly methodological, the application to the area of Madrid allows deriving important results that can be directly used to forecast travel demand and to evaluate the benefits of specific policies that might be implemented in the area. The results demonstrated, respectively: (1st) transport policy actions are more likely to be effective when pro-car intention has been disrupted first; (2nd) the consideration of “helped” and “voluntary” users as tested here could have a positive and negative impact, respectively, on the use of public transport; (3rd) the importance of density, design, diversity and accessibility underlying dimensions responsible for land use variables; and (4th) there are clearly different types of combinations of social interactions, land use and time frame on travel behavior studies. Finally, with the objective to study the impact of demand measures to change urban mobility behavior, those previous results have been considered in a unique way, a hybrid discrete choice model has been used on a 5th step. Then it can be concluded that urban mobility behavior is not only ruled by the maximum utility criterion, but also by a strong psychological-environment concept, developed without the mediation of cognitive processes during choice, i.e., many people using public transport on their way to work do not do it for utilitarian reasons, but because no other choice is available. Regarding built environment dimensions, the more diversity place of residence, the more difficult the use of public transport or walking.

Bayesian scene analysis for multi-camera 3D tracking and camera positioning

Los sistemas de seguimiento mono-cámara han demostrado su notable capacidad para el análisis de trajectorias de objectos móviles y para monitorización de escenas de interés; sin embargo, tanto su robustez como sus posibilidades en cuanto a comprensión semántica de la escena están fuertemente limitadas por su naturaleza local y monocular, lo que los hace insuficientes para aplicaciones realistas de videovigilancia. El objetivo de esta tesis es la extensión de las posibilidades de los sistemas de seguimiento de objetos móviles para lograr un mayor grado de robustez y comprensión de la escena. La extensión propuesta se divide en dos direcciones separadas. La primera puede considerarse local, ya que está orientada a la mejora y enriquecimiento de las posiciones estimadas para los objetos móviles observados directamente por las cámaras del sistema; dicha extensión se logra mediante el desarrollo de un sistema multi-cámara de seguimiento 3D, capaz de proporcionar consistentemente las posiciones 3D de múltiples objetos a partir de las observaciones capturadas por un conjunto de sensores calibrados y con campos de visión solapados. La segunda extensión puede considerarse global, dado que su objetivo consiste en proporcionar un contexto global para relacionar las observaciones locales realizadas por una cámara con una escena de mucho mayor tamaño; para ello se propone un sistema automático de localización de cámaras basado en las trayectorias observadas de varios objetos móviles y en un mapa esquemático de la escena global monitorizada. Ambas líneas de investigación se tratan utilizando, como marco común, técnicas de estimación bayesiana: esta elección está justificada por la versatilidad y flexibilidad proporcionada por dicho marco estadístico, que permite la combinación natural de múltiples fuentes de información sobre los parámetros a estimar, así como un tratamiento riguroso de la incertidumbre asociada a las mismas mediante la inclusión de modelos de observación específicamente diseñados. Además, el marco seleccionado abre grandes posibilidades operacionales, puesto que permite la creación de diferentes métodos numéricos adaptados a las necesidades y características específicas de distintos problemas tratados. El sistema de seguimiento 3D con múltiples cámaras propuesto está específicamente diseñado para permitir descripciones esquemáticas de las medidas realizadas individualmente por cada una de las cámaras del sistema: esta elección de diseño, por tanto, no asume ningún algoritmo específico de detección o seguimiento 2D en ninguno de los sensores de la red, y hace que el sistema propuesto sea aplicable a redes reales de vigilancia con capacidades limitadas tanto en términos de procesamiento como de transmision. La combinación robusta de las observaciones capturadas individualmente por las cámaras, ruidosas, incompletas y probablemente contaminadas por falsas detecciones, se basa en un metodo de asociación bayesiana basado en geometría y color: los resultados de dicha asociación permiten el seguimiento 3D de los objetos de la escena mediante el uso de un filtro de partículas. El sistema de fusión de observaciones propuesto tiene, como principales características, una gran precisión en términos de localización 3D de objetos, y una destacable capacidad de recuperación tras eventuales errores debidos a un número insuficiente de datos de entrada. El sistema automático de localización de cámaras se basa en la observación de múltiples objetos móviles y un mapa esquemático de las áreas transitables del entorno monitorizado para inferir la posición absoluta de dicho sensor. Para este propósito, se propone un novedoso marco bayesiano que combina modelos dinámicos inducidos por el mapa en los objetos móviles presentes en la escena con las trayectorias observadas por la cámara, lo que representa un enfoque nunca utilizado en la literatura existente. El sistema de localización se divide en dos sub-tareas diferenciadas, debido a que cada una de estas tareas requiere del diseño de algoritmos específicos de muestreo para explotar en profundidad las características del marco desarrollado: por un lado, análisis de la ambigüedad del caso específicamente tratado y estimación aproximada de la localización de la cámara, y por otro, refinado de la localización de la cámara. El sistema completo, diseñado y probado para el caso específico de localización de cámaras en entornos de tráfico urbano, podría tener aplicación también en otros entornos y sensores de diferentes modalidades tras ciertas adaptaciones. ABSTRACT Mono-camera tracking systems have proved their capabilities for moving object trajectory analysis and scene monitoring, but their robustness and semantic possibilities are strongly limited by their local and monocular nature and are often insufficient for realistic surveillance applications. This thesis is aimed at extending the possibilities of moving object tracking systems to a higher level of scene understanding. The proposed extension comprises two separate directions. The first one is local, since is aimed at enriching the inferred positions of the moving objects within the area of the monitored scene directly covered by the cameras of the system; this task is achieved through the development of a multi-camera system for robust 3D tracking, able to provide 3D tracking information of multiple simultaneous moving objects from the observations reported by a set of calibrated cameras with semi-overlapping fields of view. The second extension is global, as is aimed at providing local observations performed within the field of view of one camera with a global context relating them to a much larger scene; to this end, an automatic camera positioning system relying only on observed object trajectories and a scene map is designed. The two lines of research in this thesis are addressed using Bayesian estimation as a general unifying framework. Its suitability for these two applications is justified by the flexibility and versatility of that stochastic framework, which allows the combination of multiple sources of information about the parameters to estimate in a natural and elegant way, addressing at the same time the uncertainty associated to those sources through the inclusion of models designed to this end. In addition, it opens multiple possibilities for the creation of different numerical methods for achieving satisfactory and efficient practical solutions to each addressed application. The proposed multi-camera 3D tracking method is specifically designed to work on schematic descriptions of the observations performed by each camera of the system: this choice allows the use of unspecific off-the-shelf 2D detection and/or tracking subsystems running independently at each sensor, and makes the proposal suitable for real surveillance networks with moderate computational and transmission capabilities. The robust combination of such noisy, incomplete and possibly unreliable schematic descriptors relies on a Bayesian association method, based on geometry and color, whose results allow the tracking of the targets in the scene with a particle filter. The main features exhibited by the proposal are, first, a remarkable accuracy in terms of target 3D positioning, and second, a great recovery ability after tracking losses due to insufficient input data. The proposed system for visual-based camera self-positioning uses the observations of moving objects and a schematic map of the passable areas of the environment to infer the absolute sensor position. To this end, a new Bayesian framework combining trajectory observations and map-induced dynamic models for moving objects is designed, which represents an approach to camera positioning never addressed before in the literature. This task is divided into two different sub-tasks, setting ambiguity analysis and approximate position estimation, on the one hand, and position refining, on the other, since they require the design of specific sampling algorithms to correctly exploit the discriminative features of the developed framework. This system, designed for camera positioning and demonstrated in urban traffic environments, can also be applied to different environments and sensors of other modalities after certain required adaptations.

Prospective evaluation of a D-optimal designed population pharmacokinetic study

Recently, methods for computing D-optimal designs for population pharmacokinetic studies have become available. However there are few publications that have prospectively evaluated the benefits of D-optimality in population or single-subject settings. This study compared a population optimal design with an empirical design for estimating the base pharmacokinetic model for enoxaparin in a stratified randomized setting. The population pharmacokinetic D-optimal design for enoxaparin was estimated using the PFIM function (MATLAB version 6.0.0.88). The optimal design was based on a one-compartment model with lognormal between subject variability and proportional residual variability and consisted of a single design with three sampling windows (0-30 min, 1.5-5 hr and 11 - 12 hr post-dose) for all patients. The empirical design consisted of three sample time windows per patient from a total of nine windows that collectively represented the entire dose interval. Each patient was assigned to have one blood sample taken from three different windows. Windows for blood sampling times were also provided for the optimal design. Ninety six patients were recruited into the study who were currently receiving enoxaparin therapy. Patients were randomly assigned to either the optimal or empirical sampling design, stratified for body mass index. The exact times of blood samples and doses were recorded. Analysis was undertaken using NONMEM (version 5). The empirical design supported a one compartment linear model with additive residual error, while the optimal design supported a two compartment linear model with additive residual error as did the model derived from the full data set. A posterior predictive check was performed where the models arising from the empirical and optimal designs were used to predict into the full data set. This revealed the optimal'' design derived model was superior to the empirical design model in terms of precision and was similar to the model developed from the full dataset. This study suggests optimal design techniques may be useful, even when the optimized design was based on a model that was misspecified in terms of the structural and statistical models and when the implementation of the optimal designed study deviated from the nominal design.

The prevalence of childhood obesity in primary school children in urban Khon Kaen, Northeast Thailand

Childhood obesity is a serious public health problem because of its strong association with adulthood obesity and the related adverse health consequences. The published literature indicates a rising prevalence of childhood obesity in both developed and developing countries. However no data exists on the prevalence in Northeast Thailand, one of the poorest regions of the country and one that has experienced a recent economic transition. The objective of this study was to estimate the prevalence of obesity in seven to nine year old children in urban Khon Kaen, Northeast Thailand. A cross-sectional school based survey was conducted to determine the prevalence of obesity in children of urban Khon Kaen, Thailand. Multi-staged cluster sampling was used to select 12 school clusters of 72 children each between the ages of 7 and 9 years, in primary school grades 1, 2 and 3 from government, private and demonstration schools. A total of 864 seven to nine year old school children were studied. Anthropometric measurements of standing height and weight were taken for all subjects to the nearest tenth of a centimetre and tenth of a kilogram respectively. Childhood obesity was defined as a weight-for-height Z-score above 2.0 standard deviations of the National Center for Health Statistics/World Health Organisation reference population median. The prevalence of childhood obesity was 10.8% (95% CI: 7.6, 13.9). Obesity was significantly more prevalent in boys than girls. The biggest difference was observed between the three school types, with the highest prevalence of obesity found at teacher training demonstration schools and the lowest at the government schools. This study provides the first data on childhood obesity prevalence in Northeast Thailand. The prevalence of 10.8 per cent is lower than that found in two other urban areas of Thailand but slightly higher than expected for this relatively poor region. If this prevalence rate increases, as observed in other countries in economic transition, the incidence of non-communicable diseases associated with obesity is also likely to increase, thus raising cause for concern and reason for intervention to both control and prevent obesity during childhood.

A D-optimal designed population pharmacokinetic study of itraconazole capsules and solution in adults with cystic fibrosis

Background: Oral itraconazole (ITRA) is used for the treatment of allergic bronchopulmonary aspergillosis in patients with cystic fibrosis (CF) because of its antifungal activity against Aspergillus species. ITRA has an active hydroxy-metabolite (OH-ITRA) which has similar antifungal activity. ITRA is a highly lipophilic drug which is available in two different oral formulations, a capsule and an oral solution. It is reported that the oral solution has a 60% higher relative bioavailability. The influence of altered gastric physiology associated with CF on the pharmacokinetics (PK) of ITRA and its metabolite has not been previously evaluated. Objectives: 1) To estimate the population (pop) PK parameters for ITRA and its active metabolite OH-ITRA including relative bioavailability of the parent after administration of the parent by both capsule and solution and 2) to assess the performance of the optimal design. Methods: The study was a cross-over design in which 30 patients received the capsule on the first occasion and 3 days later the solution formulation. The design was constrained to have a maximum of 4 blood samples per occasion for estimation of the popPK of both ITRA and OH-ITRA. The sampling times for the population model were optimized previously using POPT v.2.0.[1] POPT is a series of applications that run under MATLAB and provide an evaluation of the information matrix for a nonlinear mixed effects model given a particular design. In addition it can be used to optimize the design based on evaluation of the determinant of the information matrix. The model details for the design were based on prior information obtained from the literature, which suggested that ITRA may have either linear or non-linear elimination. The optimal sampling times were evaluated to provide information for both competing models for the parent and metabolite and for both capsule and solution simultaneously. Blood samples were assayed by validated HPLC.[2] PopPK modelling was performed using FOCE with interaction under NONMEM, version 5 (level 1.1; GloboMax LLC, Hanover, MD, USA). The PK of ITRA and OH‑ITRA was modelled simultaneously using ADVAN 5. Subsequently three methods were assessed for modelling concentrations less than the LOD (limit of detection). These methods (corresponding to methods 5, 6 & 4 from Beal[3], respectively) were (a) where all values less than LOD were assigned to half of LOD, (b) where the closest missing value that is less than LOD was assigned to half the LOD and all previous (if during absorption) or subsequent (if during elimination) missing samples were deleted, and (c) where the contribution of the expectation of each missing concentration to the likelihood is estimated. The LOD was 0.04 mg/L. The final model evaluation was performed via bootstrap with re-sampling and a visual predictive check. The optimal design and the sampling windows of the study were evaluated for execution errors and for agreement between the observed and predicted standard errors. Dosing regimens were simulated for the capsules and the oral solution to assess their ability to achieve ITRA target trough concentration (Cmin,ss of 0.5-2 mg/L) or a combined Cmin,ss for ITRA and OH-ITRA above 1.5mg/L. Results and Discussion: A total of 241 blood samples were collected and analysed, 94% of them were taken within the defined optimal sampling windows, of which 31% where taken within 5 min of the exact optimal times. Forty six per cent of the ITRA values and 28% of the OH-ITRA values were below LOD. The entire profile after administration of the capsule for five patients was below LOD and therefore the data from this occasion was omitted from estimation. A 2-compartment model with 1st order absorption and elimination best described ITRA PK, with 1st order metabolism of the parent to OH-ITRA. For ITRA the clearance (ClItra/F) was 31.5 L/h; apparent volumes of central and peripheral compartments were 56.7 L and 2090 L, respectively. Absorption rate constants for capsule (kacap) and solution (kasol) were 0.0315 h-1 and 0.125 h-1, respectively. Comparative bioavailability of the capsule was 0.82. There was no evidence of nonlinearity in the popPK of ITRA. No screened covariate significantly improved the fit to the data. The results of the parameter estimates from the final model were comparable between the different methods for accounting for missing data, (M4,5,6)[3] and provided similar parameter estimates. The prospective application of an optimal design was found to be successful. Due to the sampling windows, most of the samples could be collected within the daily hospital routine, but still at times that were near optimal for estimating the popPK parameters. The final model was one of the potential competing models considered in the original design. The asymptotic standard errors provided by NONMEM for the final model and empirical values from bootstrap were similar in magnitude to those predicted from the Fisher Information matrix associated with the D-optimal design. Simulations from the final model showed that the current dosing regimen of 200 mg twice daily (bd) would provide a target Cmin,ss (0.5-2 mg/L) for only 35% of patients when administered as the solution and 31% when administered as capsules. The optimal dosing schedule was 500mg bd for both formulations. The target success for this dosing regimen was 87% for the solution with an NNT=4 compared to capsules. This means, for every 4 patients treated with the solution one additional patient will achieve a target success compared to capsule but at an additional cost of AUD $220 per day. The therapeutic target however is still doubtful and potential risks of these dosing schedules need to be assessed on an individual basis. Conclusion: A model was developed which described the popPK of ITRA and its main active metabolite OH-ITRA in adult CF after administration of both capsule and solution. The relative bioavailability of ITRA from the capsule was 82% that of the solution, but considerably more variable. To incorporate missing data, using the simple Beal method 5 (using half LOD for all samples below LOD) provided comparable results to the more complex but theoretically better Beal method 4 (integration method). The optimal sparse design performed well for estimation of model parameters and provided a good fit to the data.

Management information:design of a system for change identification

This thesis deals with the problem of Information Systems design for Corporate Management. It shows that the results of applying current approaches to Management Information Systems and Corporate Modelling fully justify a fresh look to the problem. The thesis develops an approach to design based on Cybernetic principles and theories. It looks at Management as an informational process and discusses the relevance of regulation theory to its practice. The work proceeds around the concept of change and its effects on the organization's stability and survival. The idea of looking at organizations as viable systems is discussed and a design to enhance survival capacity is developed. It takes Ashby's theory of adaptation and developments on ultra-stability as a theoretical framework and considering conditions for learning and foresight deduces that a design should include three basic components: A dynamic model of the organization- environment relationships; a method to spot significant changes in the value of the essential variables and in a certain set of parameters; and a Controller able to conceive and change the other two elements and to make choices among alternative policies. Further considerations of the conditions for rapid adaptation in organisms composed of many parts, and the law of Requisite Variety determine that successful adaptive behaviour requires certain functional organization. Beer's model of viable organizations is put in relation to Ashby's theory of adaptation and regulation. The use of the Ultra-stable system as abstract unit of analysis permits developing a rigorous taxonomy of change; it starts distinguishing between change with in behaviour and change of behaviour to complete the classification with organizational change. It relates these changes to the logical categories of learning connecting the topic of Information System design with that of organizational learning.

Key success factors when implementing strategic manufacturing initiatives

Purpose – This paper reports the study of key success factors (KSFs) in the project management of the implementation of strategic manufacturing initiatives (SMIs). Design/methodology/approach – In order to gather the experience and knowledge of many industries, from different geographic locations, in a broad range of types and sizes of SMIs, a questionnaire-based survey of practitioners worldwide was selected as the most appropriate research method among those available. Findings – The identification of those tasks and activities that must be done well in order to succeed in the implementation of a SMI in practice. Practical implications – Practitioners focusing their attention on the KSFs identified are more likely to succeed. Once these factors have been identified, the value of benchmarking project management methodologies then comes from drawing attention to those tasks that are key to the success of the implementation of SMIs. Originality/value – The paper presents new thinking by bringing project management into the operations strategy implementation literature as an important mediating factor for success. In this context the factors that are required for successful implementation are identified.

Breakfast skipping is associated with cyberbullying and school bullying victimization:a school-based cross-sectional study

Breakfast skipping is a health concern that has well-known negative consequences physically and psychologically. It is therefore important to understand why children skip breakfast. The purpose of this study was to establish whether the experience of bullying and cyberbullying impacts upon breakfast skipping and to further evaluate whether the inability for youths to cope with bullying victimization affects their mental health (depression), and in turn predicts breakfast skipping. Data were obtained from the Eastern Ontario 2011 Youth Risk Behaviour Survey, a cross-sectional regional school-based survey of middle and high school students (11-20 years old) across the five counties of Eastern Ontario, Canada (N = 3035). Self-reported data about children's experiences of bullying victimization, breakfast eating habits, socio-economical status, depression, and other risk behaviours were analysed. Approximately half of the participants (50.4%) reported not eating breakfast on a regular basis: 26.3% and 24.1% reported often (usually eat breakfast three times or more per week) and frequent (usually eat breakfast twice a week or less) breakfast skipping behaviour, respectively. Victims of both cyberbullying and school bullying presented greater likelihood of often (adjusted relative risk ratio (RR) = 1.55; 95% confidence interval (CI) = 1.17-2.06) and frequent (RR = 1.97; 95% CI = 1.28-3.03) breakfast skipping. Mediation analysis further showed that depression fully mediated the relationship between school bullying victimization and frequent breakfast skipping. Moreover, depression partially mediated the associations between both cyberbullying and school bullying with frequent breakfast skipping. These findings highlight the potential interrelationships between cyberbullying, school bullying and depression in predicting unhealthy breakfast skipping behaviour in children. © 2014 Elsevier Ltd.

Optimum Chemical Balance Weighing Design under Certain Condition

2000 Mathematics Subject Classification: 62K05, 05B05.

Design of high channel-count fiber Bragg gratings using tailored group delay

A novel method of fiber Bragg grating design based on tailored group delay is presented. The method leads to designs that are superior to the previously reported results. © OSA 2012.