TRial of an Educational intervention on patients' knowledge of Atrial fibrillation and anticoagulant therapy, INR control, and outcome of Treatment with warfarin (TREAT)

Background Atrial fibrillation (AF) patients with a high risk of stroke are recommended anticoagulation with warfarin. However, the benefit of warfarin is dependent upon time spent within the target therapeutic range (TTR) of their international normalised ratio (INR) (2.0 to 3.0). AF patients possess limited knowledge of their disease and warfarin treatment and this can impact on INR control. Education can improve patients' understanding of warfarin therapy and factors which affect INR control. Methods/Design Randomised controlled trial of an intensive educational intervention will consist of group sessions (between 2-8 patients) containing standardised information about the risks and benefits associated with OAC therapy, lifestyle interactions and the importance of monitoring and control of their International Normalised Ratio (INR). Information will be presented within an 'expert-patient' focussed DVD, revised educational booklet and patient worksheets. 200 warfarin-naïve patients who are eligible for warfarin will be randomised to either the intervention or usual care groups. All patients must have ECG-documented AF and be eligible for warfarin (according to the NICE AF guidelines). Exclusion criteria include: aged < 18 years old, contraindication(s) to warfarin, history of warfarin USE, valvular heart disease, cognitive impairment, are unable to speak/read English and disease likely to cause death within 12 months. Primary endpoint is time spent in TTR. Secondary endpoints include measures of quality of life (AF-QoL-18), anxiety and depression (HADS), knowledge of AF and anticoagulation, beliefs about medication (BMQ) and illness representations (IPQ-R). Clinical outcomes, including bleeding, stroke and interruption to anticoagulation will be recorded. All outcome measures will be assessed at baseline and 1, 2, 6 and 12 months post-intervention. Discussion More data is needed on the clinical benefit of educational intervention with AF patients receiving warfarin. Trial registration ISRCTN93952605

The human factors aspects of alarms in human supervisory control tasks.

This research thesis is concerned with the human factors aspects of industrial alarm systems within human supervisory control tasks. Typically such systems are located in central control rooms, and the information may be presented via visual display units. The thesis develops a human, rather than engineering, centred approach to the assessment, measurement and analysis of the situation. A human factors methodology was employed to investigate the human requirements through: interviews, questionnaires, observation and controlled experiments. Based on the analysis of current industrial alarm systems in a variety of domains (power generation, manufacturing and coronary care), it is suggested that often designers do not pay due considerations to the human requirements. It is suggested that most alarm systems have severe shortcomings in human factors terms. The interviews, questionnaire and observations led to the proposal of 'alarm initiated activities' as a framework for the research to proceed. The framework comprises of six main stages: observe, accept, analyse, investigate, correct and monitor. This framework served as a basis for laboratory research into alarm media. Under consideration were speech-based alarm displays and visual alarm displays. Non-speech auditory displays were the subject of a literature review. The findings suggest that care needs to be taken when selecting the alarm media. Ideally it should be chosen to support the task requirements of the operator, rather than being arbitrarily assigned. It was also indicated that there may be some interference between the alarm initiated activities and the alarm media, i.e. information that supports one particular stage of alarm handling may interfere with another.

Fish farm effluent control and the development of an expert system

In recent years, freshwater fish farmers have come under increasing pressure from the Water Authorities to control the quality of their farm effluents. This project aimed to investigate methods of treating aquacultural effluent in an efficient and cost-effective manner, and to incorporate the knowledge gained into an Expert System which could then be used in an advice service to farmers. From the results of this research it was established that sedimentation and the use of low pollution diets are the only cost effective methods of controlling the quality of fish farm effluents. Settlement has been extensively investigated and it was found that the removal of suspended solids in a settlement pond is only likely to be effective if the inlet solids concentration is in excess of 8 mg/litre. The probability of good settlement can be enhanced by keeping the ratio of length/retention time (a form of mean fluid velocity) below 4.0 metres/minute. The removal of BOD requires inlet solids concentrations in excess of 20 mg/litre to be effective, and this is seldom attained on commercial fish farms. Settlement, generally, does not remove appreciable quantities of ammonia from effluents, but algae can absorb ammonia by nutrient uptake under certain conditions. The use of low pollution, high performance diets gives pollutant yields which are low when compared with published figures obtained by many previous workers. Two Expert Systems were constructed, both of which diagnose possible causes of poor effluent quality on fish farms and suggest solutions. The first system uses knowledge gained from a literature review and the second employs the knowledge obtained from this project's experimental work. Consent details for over 100 fish farms were obtained from the public registers kept by the Water Authorities. Large variations in policy from one Authority to the next were found. These data have been compiled in a computer file for ease of comparison.

Privatisation, corporate control and employment growth:evidence from a panel of large Polish firms, 1996-2002

Using data on Polish firms this paper examines the relationship between corporate control structures, sales growth and the determinants of employment change. Privatised and de novo firms are the main drivers of employment growth; in the case of de novo firms, it is foreign ownership which underpins the result. Being privatised has a positive impact on employment but this is concentrated within a range of 3–6 years after privatisation. There are no systematic differences in employment response to negative sales growth across the ownership categories. Employment in state firms is less responsive to positive sales growth. From these results we infer that the behaviour of state firms is affected by both insider rent sharing and binding budget constraints.

Privatisation, corporate control and employment growth:evidence from a panel of large Polish firms, 1996-2002

Using panel data on large Polish firms this paper examines the relationship between corporate control structures, sales growth and the determinants of employment change during the period 1996-2002. We find that privatised and de novo firms are the main drivers of employment growth and that, in the case of de novo firms, it is foreign ownership which underpins the result. Interestingly, we find that being privatised has a positive impact on employment growth but that this impact is concentrated within a range of three to six years after privatisation. In contrast with the findings of earlier literature, we find evidence that there are no systematic differences in employment response to negative sales growth across the ownership categories. On the other hand, employment in state firms is less responsive to positive sales growth. From these combined results we infer that the behaviour of state firms is constrained by both insider rent sharing and binding budget constraints. Consistent with this, we find that privatised companies, three to six years post-privatisation, are the firms for whom employment is most responsive to positive sales growth and as such, offer the best hope for rapid labour market expansion.

What checkers actually check:an eye tracking study of inhibitory control and working memory

Background - Not only is compulsive checking the most common symptom in Obsessive Compulsive Disorder (OCD) with an estimated prevalence of 50–80% in patients, but approximately ~15% of the general population reveal subclinical checking tendencies that impact negatively on their performance in daily activities. Therefore, it is critical to understand how checking affects attention and memory in clinical as well as subclinical checkers. Eye fixations are commonly used as indicators for the distribution of attention but research in OCD has revealed mixed results at best. Methodology/Principal Finding - Here we report atypical eye movement patterns in subclinical checkers during an ecologically valid working memory (WM) manipulation. Our key manipulation was to present an intermediate probe during the delay period of the memory task, explicitly asking for the location of a letter, which, however, had not been part of the encoding set (i.e., misleading participants). Using eye movement measures we now provide evidence that high checkers’ inhibitory impairments for misleading information results in them checking the contents of WM in an atypical manner. Checkers fixate more often and for longer when misleading information is presented than non-checkers. Specifically, checkers spend more time checking stimulus locations as well as locations that had actually been empty during encoding. Conclusions/Significance - We conclude that these atypical eye movement patterns directly reflect internal checking of memory contents and we discuss the implications of our findings for the interpretation of behavioural and neuropsychological data. In addition our results highlight the importance of ecologically valid methodology for revealing the impact of detrimental attention and memory checking on eye movement patterns.

Diabetes Self-management Behaviors, Medical Care, Glycemic Control, and Self-rated Health in US Men by Race/Ethnicity

Men, particularly minorities, have higher rates of diabetes as compared with their counterparts. Ongoing diabetes self-management education and support by specialists are essential components to prevent the risk of complications such as kidney disease, cardiovascular diseases, and neurological impairments. Diabetes self-management behaviors, in particular, as diet and physical activity, have been associated with glycemic control in the literature. Recommended medical care for diabetes may differ by race/ethnicity. This study examined data from the National Health and Nutrition Examination Surveys, 2007 to 2010 for men with diabetes (N = 646) from four racial/ethnic groups: Mexican Americans, other Hispanics, non-Hispanic Blacks, and non-Hispanic Whites. Men with adequate dietary fiber intake had higher odds of glycemic control (odds ratio = 4.31, confidence interval [1.82, 10.20]), independent of race/ethnicity. There were racial/ethnic differences in reporting seeing a diabetes specialist. Non-Hispanic Blacks had the highest odds of reporting ever seeing a diabetes specialist (84.9%) followed by White non-Hispanics (74.7%), whereas Hispanics reported the lowest proportions (55.2% Mexican Americans and 62.1% other Hispanics). Men seeing a diabetes specialist had the lowest odds of glycemic control (odds ratio = 0.54, confidence interval [0.30, 0.96]). The results of this study suggest that diabetes education counseling may be selectively given to patients who are not in glycemic control. These findings indicate the need for examining referral systems and quality of diabetes care. Future studies should assess the effectiveness of patient-centered medical care provided by a diabetes specialist with consideration of sociodemographics, in particular, race/ethnicity and gender.

A PHR system with policy-based fine-grained access control and revocation mechanism

Collaborative sharing of information is becoming much more needed technique to achieve complex goals in today's fast-paced tech-dominant world. Personal Health Record (PHR) system has become a popular research area for sharing patients informa- tion very quickly among health professionals. PHR systems store and process sensitive information, which should have proper security mechanisms to protect patients' private data. Thus, access control mechanisms of the PHR should be well-defined. Secondly, PHRs should be stored in encrypted form. Cryptographic schemes offering a more suitable solution for enforcing access policies based on user attributes are needed for this purpose. Attribute-based encryption can resolve these problems, we propose a patient-centric framework that protects PHRs against untrusted service providers and malicious users. In this framework, we have used Ciphertext Policy Attribute Based Encryption scheme as an efficient cryptographic technique, enhancing security and privacy of the system, as well as enabling access revocation. Patients can encrypt their PHRs and store them on untrusted storage servers. They also maintain full control over access to their PHR data by assigning attribute-based access control to selected data users, and revoking unauthorized users instantly. In order to evaluate our system, we implemented CP-ABE library and web services as part of our framework. We also developed an android application based on the framework that allows users to register into the system, encrypt their PHR data and upload to the server, and at the same time authorized users can download PHR data and decrypt it. Finally, we present experimental results and performance analysis. It shows that the deployment of the proposed system would be practical and can be applied into practice.

Childhood obesity in relation to poor asthma control and exacerbations : A meta-analysis

Peer reviewed

Job control and ambulatory blood pressure

Objective: The effect of work on blood pressure (BP) in a general population with appropriate adjustment for confounders is not well defined. High job control has been found to be associated with lower BP and with nocturnal BP dipping. However, with older workers this may be compromised and has not been studied extensively. Methods: A cross-sectional study was carried out on a primary care-based sample (N=2047) aged 50–69 years. Data were collected on sociodemographic factors, medication, clinic, and ambulatory blood pressure. Job control was measured using two scales from the Copenhagen Psychosocial Questionnaire (COPSOQ) (possibility for development and influence at work). Nocturnal systolic BP (SBP) dipping was the reduction in SBP from day- to night-time using ambulatory SBP readings. Results: In general, BP increased with age, male gender, and higher body mass index. Workers with high influence at work and high possibility for development were more likely to have high asleep SBP [odds ratio (OR) 2.13, 95% confidence interval (95% CI) 1.05–4.34, P=0.04], (OR 2.27, 95% CI 1.11–4.66, P=0.03) respectively. Influence at work and awake BP were inversely associated: awake SBP (OR 2.44, 95% CI 1.35–4.41, P<0.01), awake DBP (OR 2.42, 95% CI 1.24–4.72, P=0.01). No association was seen between job control and nocturnal SBP dipping. Conclusion: Older workers with high job control may be more at risk of cardiovascular disease resulting from high day- and night-time BP with no evidence of nocturnal dipping.

(Table 1) Age control and temporal resolution of paleoceanographic records of the North Atlantic

Short-term changes in sea surface conditions controlling the thermohaline circulation in the northern North Atlantic are expected to be especially efficient in perturbing global climate stability. Here we assess past variability of sea surface temperature (SST) in the northeast Atlantic and Norwegian Sea during Marine Isotope Stage (MIS) 2 and, in particular, during the Last Glacial Maximum (LGM). Five high-resolution SST records were established on a meridional transect (53°N-72°N) to trace centennial-scale oscillations in SST and sea-ice cover. We used three independent computational techniques (SIMMAX modern analogue technique, Artificial Neural Networks (ANN), and Revised Analog Method (RAM)) to reconstruct SST from planktonic foraminifer census counts. SIMMAX and ANN reproduced short-term SST oscillations of similar magnitude and absolute levels, while RAM, owing to a restrictive analog selection, appears less suitable for reconstructing "cold end" SST. The SIMMAX and ANN SST reconstructions support the existence of a weak paleo-Norwegian Current during Dansgaard-Oeschger (DO) interstadials number 4, 3, 2, and 1. During the LGM, two warm incursions of 7°C water to occurred in the northern North Atlantic but ended north of the Iceland Faroe Ridge. A rough numerical estimate shows that the near-surface poleward heat transfer from 53° across the Iceland-Faroe Ridge up to to 72° N dropped to less than 60% of the modern value during DO interstadials and to almost zero during DO stadials. Summer sea ice was generally confined to the area north of 70°N and only rarely expanded southward along the margins of continental ice sheets. Internal LGM variability of North Atlantic (>40°N) SST in the GLAMAP 2000 compilation (Sarnthein et al., 2003, doi:10.1029/2002PA000771; Pflaumann et al., 2003, doi:10.1029/2002PA000774) indicates maximum instability in the glacial subpolar gyre and at the Iberian Margin, while in the Nordic Seas, SST was continuously low.

Threat Analysis of BlackEnergy Malware for Synchrophasor based Real-time Control and Monitoring in Smart Grid

The BlackEnergy malware targeting critical infrastructures has a long history. It evolved over time from a simple DDoS platform to a quite sophisticated plug-in based malware. The plug-in architecture has a persistent malware core with easily installable attack specific modules for DDoS, spamming, info-stealing, remote access, boot-sector formatting etc. BlackEnergy has been involved in several high profile cyber physical attacks including the recent Ukraine power grid attack in December 2015. This paper investigates the evolution of BlackEnergy and its cyber attack capabilities. It presents a basic cyber attack model used by BlackEnergy for targeting industrial control systems. In particular, the paper analyzes cyber threats of BlackEnergy for synchrophasor based systems which are used for real-time control and monitoring functionalities in smart grid. Several BlackEnergy based attack scenarios have been investigated by exploiting the vulnerabilities in two widely used synchrophasor communication standards: (i) IEEE C37.118 and (ii) IEC 61850-90-5. Specifically, the paper addresses reconnaissance, DDoS, man-in-the-middle and replay/reflection attacks on IEEE C37.118 and IEC 61850-90-5. Further, the paper also investigates protection strategies for detection and prevention of BlackEnergy based cyber physical attacks.

Preschoolers’ Executive Control and Diurnal Cortisol as Mediators of the Relations of Prenatal Stress to Child Adjustment

Thesis (Ph.D.)--University of Washington, 2016-08

Supervisory control of (max,+) automata: extensions towards applications

International audience

Spanish/English Bilingualism and Finitness Acquisition

Se ofrece un análisis del lenguaje de una niña bilingüe (Mina) con la intención de comprobar la teoría de Wexler quien dice que el lenguaje de los niños presenta un período de uso 'opcional de formas verbales infinitivas' en contextos en los que adultos no las usarían. Se presenta importante información relacionada con el tema y se analizan las muestras de idioma para concluir que sí hay evidencia para la existencia de dicho período en ambos idiomas: éste se expresa en inglés a través de formas infinitivas y en español en verbos que varían aspectualmente y que aparecen en predicados que no tienen concordancia con su sujeto. Además se comparan los resultados de varios estudios de diferentes lenguas.This paper presents the analysis of the speech of a bilingual child (Mina) in order to determine if the 'Optional Infinitive Stage' (OI) (Wexler) is present in her language production at this stage of language development (So). The first part presents important background information. Then, the English and Spanish data are analyzed to conclude that the Optional Infinitive stage is expressed both in Spanish and in English through different mechanisms, Root Infinitives in English and 'aspectually variable' verbs that appear as 'misagreeing' predicates in Spanish.