Predicting 3-year mortality after percutaneous coronary intervention: updated logistic clinical SYNTAX score based on patient-level data from 7 contemporary stent trials

OBJECTIVES This study aimed to update the Logistic Clinical SYNTAX score to predict 3-year survival after percutaneous coronary intervention (PCI) and compare the performance with the SYNTAX score alone. BACKGROUND The SYNTAX score is a well-established angiographic tool to predict long-term outcomes after PCI. The Logistic Clinical SYNTAX score, developed by combining clinical variables with the anatomic SYNTAX score, has been shown to perform better than the SYNTAX score alone in predicting 1-year outcomes after PCI. However, the ability of this score to predict long-term survival is unknown. METHODS Patient-level data (N = 6,304, 399 deaths within 3 years) from 7 contemporary PCI trials were analyzed. We revised the overall risk and the predictor effects in the core model (SYNTAX score, age, creatinine clearance, and left ventricular ejection fraction) using Cox regression analysis to predict mortality at 3 years. We also updated the extended model by combining the core model with additional independent predictors of 3-year mortality (i.e., diabetes mellitus, peripheral vascular disease, and body mass index). RESULTS The revised Logistic Clinical SYNTAX models showed better discriminative ability than the anatomic SYNTAX score for the prediction of 3-year mortality after PCI (c-index: SYNTAX score, 0.61; core model, 0.71; and extended model, 0.73 in a cross-validation procedure). The extended model in particular performed better in differentiating low- and intermediate-risk groups. CONCLUSIONS Risk scores combining clinical characteristics with the anatomic SYNTAX score substantially better predict 3-year mortality than the SYNTAX score alone and should be used for long-term risk stratification of patients undergoing PCI.

Improving Pediatric Basic Life Support Performance Through Blended Learning With Web-Based Virtual Patients: Randomized Controlled Trial

BACKGROUND E-learning and blended learning approaches gain more and more popularity in emergency medicine curricula. So far, little data is available on the impact of such approaches on procedural learning and skill acquisition and their comparison with traditional approaches. OBJECTIVE This study investigated the impact of a blended learning approach, including Web-based virtual patients (VPs) and standard pediatric basic life support (PBLS) training, on procedural knowledge, objective performance, and self-assessment. METHODS A total of 57 medical students were randomly assigned to an intervention group (n=30) and a control group (n=27). Both groups received paper handouts in preparation of simulation-based PBLS training. The intervention group additionally completed two Web-based VPs with embedded video clips. Measurements were taken at randomization (t0), after the preparation period (t1), and after hands-on training (t2). Clinical decision-making skills and procedural knowledge were assessed at t0 and t1. PBLS performance was scored regarding adherence to the correct algorithm, conformance to temporal demands, and the quality of procedural steps at t1 and t2. Participants' self-assessments were recorded in all three measurements. RESULTS Procedural knowledge of the intervention group was significantly superior to that of the control group at t1. At t2, the intervention group showed significantly better adherence to the algorithm and temporal demands, and better procedural quality of PBLS in objective measures than did the control group. These aspects differed between the groups even at t1 (after VPs, prior to practical training). Self-assessments differed significantly only at t1 in favor of the intervention group. CONCLUSIONS Training with VPs combined with hands-on training improves PBLS performance as judged by objective measures.

Internet as a medium to seek partners among men who have sex with men

While there are reports of developing sexual relationships on the Internet (I) among MSM, there are few reports that have examined the process of developing sexual relationships on the I and comparing to that in real life (IRL). This study examines the process to provide insight into how MSM make decisions about courtship, engages in negotiations for sex, and choose sexual partners and examines the comparative sexual risks taken between I vs. IRL negotiation. This self-selected convenience sample at a national level (n=1001) of MSM recruited through the I, systematically explored the different steps, the process of courtship in a flow chart of I and IRL dating to portray the process of filtering, courtship and/or negotiation for sex. Risk behaviors in both environments are presented along with interactions that create predictable sequences or "scripts". These sequences constitute 'filtering' and 'sexual positioning'. Differences between I & IRL suggest discussion of HIV/STD status to have consistent differences for all variables except 'unprotected sex' meaning no condom use. There was more communication on the I in regards to self revealing information or variables relating to reducing risks which enable 'filtering' (including serosorting). Data indicate more steps in the I process, providing more complex, multiple steps to filter and position with regard not only to HIV/STD risk but also to negotiate position for complementary sexual interest. The study established a pattern of MSM's courtships or negotiation for sex and a pattern of acquisition, and more I negotiation. Data suggest negotiation opportunities which could lend to intervention to advise people how to negotiate safely. ^ Previous studies have reviewed MSM and drug use. This is a study to review the process of drug use associated with sexual behavior regarding the Internet (I) and in real life (IRL) using a self-selected, convenience sample of MSM (n=1001) recruited nation-wide through the Internet. Data on MSM and drugs illustrate the Internet being used as a tool to filter for drug use among MSM. MSM's drug use in both environments highlights the use of sexual performance drugs with an IRL pursuit of intimacy or negotiation for sex. IRL encounters were more likely to involve drug use (both recreational and sexual performance-enhancing) than Internet encounters. This may be due to more IRL meetings occurring at bars, clubs or parties where drug use is a norm. Compared with IRL, the Internet may provide a venue for persons who do not want to use drugs to select partners with similar attitudes. This suggests that filtering may be occurring as part of the internet negotiation. Data indicated that IRL persons get drunk/high before having sex in past 60 days significantly more often than Internet participants. Age did not alter the pattern of results. Thus drug filtering is really not recreational drug filtering or selecting for PNP, but appears to be situationally-based. Thus, it should perhaps be seen as another form of filtering to select drug-free partners, rather than using the Internet to specifically recruit and interact with other recreational drug users. ^

Intelligent context-aware services based on internet of things architectures

La Internet de las Cosas (IoT), como parte de la Futura Internet, se ha convertido en la actualidad en uno de los principales temas de investigación; en parte gracias a la atención que la sociedad está poniendo en el desarrollo de determinado tipo de servicios (telemetría, generación inteligente de energía, telesanidad, etc.) y por las recientes previsiones económicas que sitúan a algunos actores, como los operadores de telecomunicaciones (que se encuentran desesperadamente buscando nuevas oportunidades), al frente empujando algunas tecnologías interrelacionadas como las comunicaciones Máquina a Máquina (M2M). En este contexto, un importante número de actividades de investigación a nivel mundial se están realizando en distintas facetas: comunicaciones de redes de sensores, procesado de información, almacenamiento de grandes cantidades de datos (big--‐data), semántica, arquitecturas de servicio, etc. Todas ellas, de forma independiente, están llegando a un nivel de madurez que permiten vislumbrar la realización de la Internet de las Cosas más que como un sueño, como una realidad tangible. Sin embargo, los servicios anteriormente mencionados no pueden esperar a desarrollarse hasta que las actividades de investigación obtengan soluciones holísticas completas. Es importante proporcionar resultados intermedios que eviten soluciones verticales realizadas para desarrollos particulares. En este trabajo, nos hemos focalizado en la creación de una plataforma de servicios que pretende facilitar, por una parte la integración de redes de sensores y actuadores heterogéneas y geográficamente distribuidas, y por otra lado el desarrollo de servicios horizontales utilizando dichas redes y la información que proporcionan. Este habilitador se utilizará para el desarrollo de servicios y para la experimentación en la Internet de las Cosas. Previo a la definición de la plataforma, se ha realizado un importante estudio focalizando no sólo trabajos y proyectos de investigación, sino también actividades de estandarización. Los resultados se pueden resumir en las siguientes aseveraciones: a) Los modelos de datos definidos por el grupo “Sensor Web Enablement” (SWE™) del “Open Geospatial Consortium (OGC®)” representan hoy en día la solución más completa para describir las redes de sensores y actuadores así como las observaciones. b) Las interfaces OGC, a pesar de las limitaciones que requieren cambios y extensiones, podrían ser utilizadas como las bases para acceder a sensores y datos. c) Las redes de nueva generación (NGN) ofrecen un buen sustrato que facilita la integración de redes de sensores y el desarrollo de servicios. En consecuencia, una nueva plataforma de Servicios, llamada Ubiquitous Sensor Networks (USN), se ha definido en esta Tesis tratando de contribuir a rellenar los huecos previamente mencionados. Los puntos más destacados de la plataforma USN son: a) Desde un punto de vista arquitectónico, sigue una aproximación de dos niveles (Habilitador y Gateway) similar a otros habilitadores que utilizan las NGN (como el OMA Presence). b) Los modelos de datos están basado en los estándares del OGC SWE. iv c) Está integrado en las NGN pero puede ser utilizado sin ellas utilizando infraestructuras IP abiertas. d) Las principales funciones son: Descubrimiento de sensores, Almacenamiento de observaciones, Publicacion--‐subscripcion--‐notificación, ejecución remota homogénea, seguridad, gestión de diccionarios de datos, facilidades de monitorización, utilidades de conversión de protocolos, interacciones síncronas y asíncronas, soporte para el “streaming” y arbitrado básico de recursos. Para demostrar las funcionalidades que la Plataforma USN propuesta pueden ofrecer a los futuros escenarios de la Internet de las Cosas, se presentan resultados experimentales de tres pruebas de concepto (telemetría, “Smart Places” y monitorización medioambiental) reales a pequeña escala y un estudio sobre semántica (sistema de información vehicular). Además, se está utilizando actualmente como Habilitador para desarrollar tanto experimentación como servicios reales en el proyecto Europeo SmartSantander (que aspira a integrar alrededor de 20.000 dispositivos IoT). v Abstract Internet of Things, as part of the Future Internet, has become one of the main research topics nowadays; in part thanks to the pressure the society is putting on the development of a particular kind of services (Smart metering, Smart Grids, eHealth, etc.), and by the recent business forecasts that situate some players, like Telecom Operators (which are desperately seeking for new opportunities), at the forefront pushing for some interrelated technologies like Machine--‐to--‐Machine (M2M) communications. Under this context, an important number of research activities are currently taking place worldwide at different levels: sensor network communications, information processing, big--‐ data storage, semantics, service level architectures, etc. All of them, isolated, are arriving to a level of maturity that envision the achievement of Internet of Things (IoT) more than a dream, a tangible goal. However, the aforementioned services cannot wait to be developed until the holistic research actions bring complete solutions. It is important to come out with intermediate results that avoid vertical solutions tailored for particular deployments. In the present work, we focus on the creation of a Service--‐level platform intended to facilitate, from one side the integration of heterogeneous and geographically disperse Sensors and Actuator Networks (SANs), and from the other the development of horizontal services using them and the information they provide. This enabler will be used for horizontal service development and for IoT experimentation. Prior to the definition of the platform, we have realized an important study targeting not just research works and projects, but also standardization topics. The results can be summarized in the following assertions: a) Open Geospatial Consortium (OGC®) Sensor Web Enablement (SWE™) data models today represent the most complete solution to describe SANs and observations. b) OGC interfaces, despite the limitations that require changes and extensions, could be used as the bases for accessing sensors and data. c) Next Generation Networks (NGN) offer a good substrate that facilitates the integration of SANs and the development of services. Consequently a new Service Layer platform, called Ubiquitous Sensor Networks (USN), has been defined in this Thesis trying to contribute to fill in the previous gaps. The main highlights of the proposed USN Platform are: a) From an architectural point of view, it follows a two--‐layer approach (Enabler and Gateway) similar to other enablers that run on top of NGN (like the OMA Presence). b) Data models and interfaces are based on the OGC SWE standards. c) It is integrated in NGN but it can be used without it over open IP infrastructures. d) Main functions are: Sensor Discovery, Observation Storage, Publish--‐Subscribe--‐Notify, homogeneous remote execution, security, data dictionaries handling, monitoring facilities, authorization support, protocol conversion utilities, synchronous and asynchronous interactions, streaming support and basic resource arbitration. vi In order to demonstrate the functionalities that the proposed USN Platform can offer to future IoT scenarios, some experimental results have been addressed in three real--‐life small--‐scale proofs--‐of concepts (Smart Metering, Smart Places and Environmental monitoring) and a study for semantics (in--‐vehicle information system). Furthermore we also present the current use of the proposed USN Platform as an Enabler to develop experimentation and real services in the SmartSantander EU project (that aims at integrating around 20.000 IoT devices).

Combining Wireless Sensor Networks and Semantic Middleware for an Internet of Things-Based Sportsman/Woman Monitoring Application.

Wireless Sensor Networks (WSNs) are spearheading the efforts taken to build and deploy systems aiming to accomplish the ultimate objectives of the Internet of Things. Due to the sensors WSNs nodes are provided with, and to their ubiquity and pervasive capabilities, these networks become extremely suitable for many applications that so-called conventional cabled or wireless networks are unable to handle. One of these still underdeveloped applications is monitoring physical parameters on a person. This is an especially interesting application regarding their age or activity, for any detected hazardous parameter can be notified not only to the monitored person as a warning, but also to any third party that may be helpful under critical circumstances, such as relatives or healthcare centers. We propose a system built to monitor a sportsman/woman during a workout session or performing a sport-related indoor activity. Sensors have been deployed by means of several nodes acting as the nodes of a WSN, along with a semantic middleware development used for hardware complexity abstraction purposes. The data extracted from the environment, combined with the information obtained from the user, will compose the basis of the services that can be obtained.

A proposal for an Internet of Things-based monitoring system composed by low capability, open source and open hardware devices

The Internet of Things makes use of a huge disparity of technologies at very different levels that help one to the other to accomplish goals that were previously regarded as unthinkable in terms of ubiquity or scalability. If the Internet of Things is expected to interconnect every day devices or appliances and enable communications between them, a broad range of new services, applications and products can be foreseen. For example, monitoring is a process where sensors have widespread use for measuring environmental parameters (temperature, light, chemical agents, etc.) but obtaining readings at the exact physical point they want to be obtained from, or about the exact wanted parameter can be a clumsy, time-consuming task that is not easily adaptable to new requirements. In order to tackle this challenge, a proposal on a system used to monitor any conceivable environment, which additionally is able to monitor the status of its own components and heal some of the most usual issues of a Wireless Sensor Network, is presented here in detail, covering all the layers that give it shape in terms of devices, communications or services.

Self-adaptive strategy based on fuzzy control systems for improving performance in wireless sensors networks

The solutions to cope with new challenges that societies have to face nowadays involve providing smarter daily systems. To achieve this, technology has to evolve and leverage physical systems automatic interactions, with less human intervention. Technological paradigms like Internet of Things (IoT) and Cyber-Physical Systems (CPS) are providing reference models, architectures, approaches and tools that are to support cross-domain solutions. Thus, CPS based solutions will be applied in different application domains like e-Health, Smart Grid, Smart Transportation and so on, to assure the expected response from a complex system that relies on the smooth interaction and cooperation of diverse networked physical systems. The Wireless Sensors Networks (WSN) are a well-known wireless technology that are part of large CPS. The WSN aims at monitoring a physical system, object, (e.g., the environmental condition of a cargo container), and relaying data to the targeted processing element. The WSN communication reliability, as well as a restrained energy consumption, are expected features in a WSN. This paper shows the results obtained in a real WSN deployment, based on SunSPOT nodes, which carries out a fuzzy based control strategy to improve energy consumption while keeping communication reliability and computational resources usage among boundaries.

Development of a fuzzy control based self-adaptive system for energy saving in constrained networks for the Internet of Things

Las redes del futuro, incluyendo las redes de próxima generación, tienen entre sus objetivos de diseño el control sobre el consumo de energía y la conectividad de la red. Estos objetivos cobran especial relevancia cuando hablamos de redes con capacidades limitadas, como es el caso de las redes de sensores inalámbricos (WSN por sus siglas en inglés). Estas redes se caracterizan por estar formadas por dispositivos de baja o muy baja capacidad de proceso y por depender de baterías para su alimentación. Por tanto la optimización de la energía consumida se hace muy importante. Son muchas las propuestas que se han realizado para optimizar el consumo de energía en este tipo de redes. Quizás las más conocidas son las que se basan en la planificación coordinada de periodos de actividad e inactividad, siendo una de las formas más eficaces para extender el tiempo de vida de las baterías. La propuesta que se presenta en este trabajo se basa en el control de la conectividad mediante una aproximación probabilística. La idea subyacente es que se puede esperar que una red mantenga la conectividad si todos sus nodos tienen al menos un número determinado de vecinos. Empleando algún mecanismo que mantenga ese número, se espera que se pueda mantener la conectividad con un consumo energético menor que si se empleara una potencia de transmisión fija que garantizara una conectividad similar. Para que el mecanismo sea eficiente debe tener la menor huella posible en los dispositivos donde se vaya a emplear. Por eso se propone el uso de un sistema auto-adaptativo basado en control mediante lógica borrosa. En este trabajo se ha diseñado e implementado el sistema descrito, y se ha probado en un despliegue real confirmando que efectivamente existen configuraciones posibles que permiten mantener la conectividad ahorrando energía con respecto al uso de una potencia de transmisión fija. ABSTRACT. Among the design goals for future networks, including next generation networks, we can find the energy consumption and the connectivity. These two goals are of special relevance when dealing with constrained networks. That is the case of Wireless Sensors Networks (WSN). These networks consist of devices with low or very low processing capabilities. They also depend on batteries for their operation. Thus energy optimization becomes a very important issue. Several proposals have been made for optimizing the energy consumption in this kind of networks. Perhaps the best known are those based on the coordinated planning of active and sleep intervals. They are indeed one of the most effective ways to extend the lifetime of the batteries. The proposal presented in this work uses a probabilistic approach to control the connectivity of a network. The underlying idea is that it is highly probable that the network will have a good connectivity if all the nodes have a minimum number of neighbors. By using some mechanism to reach that number, we hope that we can preserve the connectivity with a lower energy consumption compared to the required one if a fixed transmission power is used to achieve a similar connectivity. The mechanism must have the smallest footprint possible on the devices being used in order to be efficient. Therefore a fuzzy control based self-adaptive system is proposed. This work includes the design and implementation of the described system. It also has been validated in a real scenario deployment. We have obtained results supporting that there exist configurations where it is possible to get a good connectivity saving energy when compared to the use of a fixed transmission power for a similar connectivity.

Antitrust, Regulation and the Neutrality Trap: A plea for a smart, evidence-based internet policy. CEPS Special Report No. 104/April 2015

When they look at Internet policy, EU policymakers seem mesmerised, if not bewitched, by the word ‘neutrality’. Originally confined to the infrastructure layer, today the neutrality rhetoric is being expanded to multi-sided platforms such as search engines and more generally online intermediaries. Policies for search neutrality and platform neutrality are invoked to pursue a variety of policy objectives, encompassing competition, consumer protection, privacy and media pluralism. This paper analyses this emerging debate and comes to a number of conclusions. First, mandating net neutrality at the infrastructure layer might have some merit, but it certainly would not make the Internet neutral. Second, since most of the objectives initially associated with network neutrality cannot be realistically achieved by such a rule, the case for network neutrality legislation would have to stand on different grounds. Third, the fact that the Internet is not neutral is mostly a good thing for end users, who benefit from intermediaries that provide them with a selection of the over-abundant information available on the Web. Fourth, search neutrality and platform neutrality are fundamentally flawed principles that contradict the economics of the Internet. Fifth, neutrality is a very poor and ineffective recipe for media pluralism, and as such should not be invoked as the basis of future media policy. All these conclusions have important consequences for the debate on the future EU policy for the Digital Single Market.

Lightweight Internet Traffic Classification - A Subject Based Solution with Word Embeddings

Internet traffic classification is a relevant and mature research field, anyway of growing importance and with still open technical challenges, also due to the pervasive presence of Internet-connected devices into everyday life. We claim the need for innovative traffic classification solutions capable of being lightweight, of adopting a domain-based approach, of not only concentrating on application-level protocol categorization but also classifying Internet traffic by subject. To this purpose, this paper originally proposes a classification solution that leverages domain name information extracted from IPFIX summaries, DNS logs, and DHCP leases, with the possibility to be applied to any kind of traffic. Our proposed solution is based on an extension of Word2vec unsupervised learning techniques running on a specialized Apache Spark cluster. In particular, learning techniques are leveraged to generate word-embeddings from a mixed dataset composed by domain names and natural language corpuses in a lightweight way and with general applicability. The paper also reports lessons learnt from our implementation and deployment experience that demonstrates that our solution can process 5500 IPFIX summaries per second on an Apache Spark cluster with 1 slave instance in Amazon EC2 at a cost of $ 3860 year. Reported experimental results about Precision, Recall, F-Measure, Accuracy, and Cohen's Kappa show the feasibility and effectiveness of the proposal. The experiments prove that words contained in domain names do have a relation with the kind of traffic directed towards them, therefore using specifically trained word embeddings we are able to classify them in customizable categories. We also show that training word embeddings on larger natural language corpuses leads improvements in terms of precision up to 180%.

Illinois annual performance report : Early Intervention Program /

The Illinois Early Intervention Services Act required the Illinois Department of Human Services (DHS) to submit to the Governor a five-fiscal year implementation plan and to annually report to the Governor and the General Assembly on the status of early intervention programs for eligible infants and toddlers and their families in Illinois.

Socio-Historical Factors Mediating Collaborative Teaching and Learning: A Design-Based Investigation and Intervention

Thesis (Ph.D.)--University of Washington, 2016-06