Detection of significant coronary artery disease by noninvasive anatomical and functional imaging.

BACKGROUND The choice of imaging techniques in patients with suspected coronary artery disease (CAD) varies between countries, regions, and hospitals. This prospective, multicenter, comparative effectiveness study was designed to assess the relative accuracy of commonly used imaging techniques for identifying patients with significant CAD. METHODS AND RESULTS A total of 475 patients with stable chest pain and intermediate likelihood of CAD underwent coronary computed tomographic angiography and stress myocardial perfusion imaging by single photon emission computed tomography or positron emission tomography, and ventricular wall motion imaging by stress echocardiography or cardiac magnetic resonance. If ≥1 test was abnormal, patients underwent invasive coronary angiography. Significant CAD was defined by invasive coronary angiography as >50% stenosis of the left main stem, >70% stenosis in a major coronary vessel, or 30% to 70% stenosis with fractional flow reserve ≤0.8. Significant CAD was present in 29% of patients. In a patient-based analysis, coronary computed tomographic angiography had the highest diagnostic accuracy, the area under the receiver operating characteristics curve being 0.91 (95% confidence interval, 0.88-0.94), sensitivity being 91%, and specificity being 92%. Myocardial perfusion imaging had good diagnostic accuracy (area under the curve, 0.74; confidence interval, 0.69-0.78), sensitivity 74%, and specificity 73%. Wall motion imaging had similar accuracy (area under the curve, 0.70; confidence interval, 0.65-0.75) but lower sensitivity (49%, P<0.001) and higher specificity (92%, P<0.001). The diagnostic accuracy of myocardial perfusion imaging and wall motion imaging were lower than that of coronary computed tomographic angiography (P<0.001). CONCLUSIONS In a multicenter European population of patients with stable chest pain and low prevalence of CAD, coronary computed tomographic angiography is more accurate than noninvasive functional testing for detecting significant CAD defined invasively. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00979199.

Fine-grained indoor positioning and tracking systems

Indoor positioning has attracted considerable attention for decades due to the increasing demands for location based services. In the past years, although numerous methods have been proposed for indoor positioning, it is still challenging to find a convincing solution that combines high positioning accuracy and ease of deployment. Radio-based indoor positioning has emerged as a dominant method due to its ubiquitousness, especially for WiFi. RSSI (Received Signal Strength Indicator) has been investigated in the area of indoor positioning for decades. However, it is prone to multipath propagation and hence fingerprinting has become the most commonly used method for indoor positioning using RSSI. The drawback of fingerprinting is that it requires intensive labour efforts to calibrate the radio map prior to experiments, which makes the deployment of the positioning system very time consuming. Using time information as another way for radio-based indoor positioning is challenged by time synchronization among anchor nodes and timestamp accuracy. Besides radio-based positioning methods, intensive research has been conducted to make use of inertial sensors for indoor tracking due to the fast developments of smartphones. However, these methods are normally prone to accumulative errors and might not be available for some applications, such as passive positioning. This thesis focuses on network-based indoor positioning and tracking systems, mainly for passive positioning, which does not require the participation of targets in the positioning process. To achieve high positioning accuracy, we work on some information of radio signals from physical-layer processing, such as timestamps and channel information. The contributions in this thesis can be divided into two parts: time-based positioning and channel information based positioning. First, for time-based indoor positioning (especially for narrow-band signals), we address challenges for compensating synchronization offsets among anchor nodes, designing timestamps with high resolution, and developing accurate positioning methods. Second, we work on range-based positioning methods with channel information to passively locate and track WiFi targets. Targeting less efforts for deployment, we work on range-based methods, which require much less calibration efforts than fingerprinting. By designing some novel enhanced methods for both ranging and positioning (including trilateration for stationary targets and particle filter for mobile targets), we are able to locate WiFi targets with high accuracy solely relying on radio signals and our proposed enhanced particle filter significantly outperforms the other commonly used range-based positioning algorithms, e.g., a traditional particle filter, extended Kalman filter and trilateration algorithms. In addition to using radio signals for passive positioning, we propose a second enhanced particle filter for active positioning to fuse inertial sensor and channel information to track indoor targets, which achieves higher tracking accuracy than tracking methods solely relying on either radio signals or inertial sensors.

Fine-grained Indoor Tracking by Fusing Inertial Sensor and Physical Layer Information in WLANs

Indoor positioning has become an emerging research area because of huge commercial demands for location-based services in indoor environments. Channel State Information (CSI) as fine-grained physical layer information has been recently proposed to achieve high positioning accuracy by using range based methods, e.g., trilateration. In this work, we propose to fuse the CSI-based ranging and velocity estimated from inertial sensors by an enhanced particle filter to achieve highly accurate tracking. The algorithm relies on some enhanced ranging methods and further mitigates the remaining ranging errors by a weighting technique. Additionally, we provide an efficient method to estimate the velocity based on inertial sensors. The algorithms are designed in a network-based system, which uses rather cheap commercial devices as anchor nodes. We evaluate our system in a complex environment along three different moving paths. Our proposed tracking method can achieve 1.3m for mean accuracy and 2.2m for 90% accuracy, which is more accurate and stable than pedestrian dead reckoning and range-based positioning.

Evaluation of epidemiological and clinical factors in survival of patients with de novo myelodysplastic syndrome at the University of Texas MD Anderson cancer center

Little is known about epidemiological markers that are associated with survival of patients with myelodysplastic syndromes (MDS). We conducted a secondary case-based analysis of 465 de novo MDS patients from the University of Texas MD Anderson Cancer Center (UTMDACC). We investigated the association between demographic as well as occupational exposure markers and survival while incorporating known clinical markers of prognosis. In our patient population, 60.6% were men and the majority were white (93.1%). The distribution of MDS subtypes by the French–American–British (FAB) classification was 81 (19%) refractory anemia (RA), 46 (9.9%) refractory anemia with ringed sideroblasts (RARS), 57 (12.3%) chronic myelomonocytic leukemia (CMML), 173 (37.2%) RA with excess blasts (RAEB), and 86 (18.5%) RAEB in transformation (RAEBT). We found that those older at diagnosis (> 60 years of age) (HR = 1.68, CI = 1.26-2.25) were at a higher risk of dying compared to younger patients. Similarly, high pack years of smoking (>= 30 pack years of smoking) (HR = 1.34, CI = 1.02-1.74), and agricultural chemical exposure (HR = 1.61, CI = 1.05-2.46) were significantly associated with overall lower survival when compared to patients with none or medium exposures. Among clinical markers, greater than 5% bone marrow blasts (HR = 1.81 CI = 1.27-2.56), poor cytogenetics (HR = 3.20, CI = 2.37-4.33)), and platelet cytopenias (<100000/ul) (HR = 1.46, CI = 1.11-1.92) were also significantly associated with overall MDS survival.^ The identification of epidemiological markers could help physicians stratify patients and customize treatment strategies to improve the outcome of MDS based on patient lifestyle information such as smoking exposure and agrochemical exposure. We hope that this study highlights the impact of these exposures in MDS prognosis.^

Exploration of genetic susceptibility to pancreatic cancer: A GWAS approach

Pancreatic cancer is the 4th most common cause for cancer death in the United States, accompanied by less than 5% five-year survival rate based on current treatments, particularly because it is usually detected at a late stage. Identifying a high-risk population to launch an effective preventive strategy and intervention to control this highly lethal disease is desperately needed. The genetic etiology of pancreatic cancer has not been well profiled. We hypothesized that unidentified genetic variants by previous genome-wide association study (GWAS) for pancreatic cancer, due to stringent statistical threshold or missing interaction analysis, may be unveiled using alternative approaches. To achieve this aim, we explored genetic susceptibility to pancreatic cancer in terms of marginal associations of pathway and genes, as well as their interactions with risk factors. We conducted pathway- and gene-based analysis using GWAS data from 3141 pancreatic cancer patients and 3367 controls with European ancestry. Using the gene set ridge regression in association studies (GRASS) method, we analyzed 197 pathways from the Kyoto Encyclopedia of Genes and Genomes (KEGG) database. Using the logistic kernel machine (LKM) test, we analyzed 17906 genes defined by University of California Santa Cruz (UCSC) database. Using the likelihood ratio test (LRT) in a logistic regression model, we analyzed 177 pathways and 17906 genes for interactions with risk factors in 2028 pancreatic cancer patients and 2109 controls with European ancestry. After adjusting for multiple comparisons, six pathways were marginally associated with risk of pancreatic cancer ( P < 0.00025): Fc epsilon RI signaling, maturity onset diabetes of the young, neuroactive ligand-receptor interaction, long-term depression (Ps < 0.0002), and the olfactory transduction and vascular smooth muscle contraction pathways (P = 0.0002; Nine genes were marginally associated with pancreatic cancer risk (P < 2.62 × 10−5), including five reported genes (ABO, HNF1A, CLPTM1L, SHH and MYC), as well as four novel genes (OR13C4, OR 13C3, KCNA6 and HNF4 G); three pathways significantly interacted with risk factors on modifying the risk of pancreatic cancer (P < 2.82 × 10−4): chemokine signaling pathway with obesity ( P < 1.43 × 10−4), calcium signaling pathway (P < 2.27 × 10−4) and MAPK signaling pathway with diabetes (P < 2.77 × 10−4). However, none of the 17906 genes tested for interactions survived the multiple comparisons corrections. In summary, our current GWAS study unveiled unidentified genetic susceptibility to pancreatic cancer using alternative methods. These novel findings provide new perspectives on genetic susceptibility to and molecular mechanisms of pancreatic cancer, once confirmed, will shed promising light on the prevention and treatment of this disease. ^

Strange bedfellows: The ethics and politics of medical futility in Texas

Background: Futile medical treatments are interventions that are not associated with a benefit to the patient. The definition and concept of medical futility are controversial. The Texas Advance Directives Act (TADA) was passed in 1999 to address medically inappropriate interventions by allowing providers to withdraw inappropriate interventions against a surrogate decision maker's wishes following a review, attempt to transfer the patient, and 10-day waiting period. The original legislation was a negotiated compromise by players across the political spectrum. However, in recent years there has been increasing controversy regarding TADA and attempts to alter its applicability in Texas. ^ Purpose: The purpose of this project was to apply Paul Sabatier's advocacy coalition framework (ACF) to gain understanding into the historical, ethical, and political basis of the initial compromise, and determine the sources of conflict that have led to increased opposition to TADA. ^ Methods: Using the ACF model, key actors within the medical futility policy debate in Texas were aggregated into coalitions based on shared beliefs. A narrative summary based analysis identified the core elements of the policy subsystem, as well as the constraints and resources of the subsystem actors. Externalities that promoted adjustments to coalition beliefs and tactics used by coalition participants were analyzed. Data sources included review of the published literature regarding medical futility, as well as analysis of published newspaper accounts and editorials regarding the medical futility issue in Texas, legislative testimony, and review of weblogs and online commentaries dealing with the issue. ^ Results: Primary coalition participants in developing compromise legislation in 1999 were the Providers and Vitalists, with Autonomists gaining a prominent role starting in 2006. Internal factors associated with the breakdown of consensus included changes to the makeup of the governing coalition and changes in individual case information available to the Vitalist coalition. Externalities related to the intertwining of the Sun Hudson case and the Terri Schiavo case generated negative publicity for the TADA from progressive and conservative viewpoints. Dissemination of information in various venues regarding contentious cases was associated with more polarization of viewpoints, and realignment of coalition alliances. ^ Conclusions: The ACF provided an outline for the initial compromise over the creation of the Texas Advance Directives Act as well as the eventual loss of consensus. The debate between the Provider, Vitalist, and Autonomist coalitions has been affected by internal policy evolution, changes in the governing coalition, and important externalities. The debate over medical futility in Texas has had much broader implications in the dispute over Health Care Reform.^

Obtención de un estándar secundario de cuantificación para la síntesis y purificación de allicina.

Desde tiempos ancestrales, el ajo (Allium sativum L.) ha sido utilizado para la prevención y el tratamiento de dolencias. Sus efectos benéficos para la salud han sido atribuidos a los tiosulfinatos, siendo la allicina el más abundante. La determinación rutinaria de la allicina es dificultosa dada su inestabilidad y la naturaleza reactiva de la misma. El objetivo del trabajo fue obtener un estándar secundario para la cuantificación de allicina mediante Cromatografía Líquida de Alta Resolución (HPLC). Fueron ensayadas diferentes metodologías de síntesis y purificación de allicina. En el Laboratorio de Residuos Tóxicos de la Fac. Cs. Agrarias (UNCuyo), bajo condiciones controladas, se preparó polvo de ajo para ser utilizado como estándar secundario de cuantificación. La cuantificación de muestras problema contra ambos estándares (allicina pura y polvo de ajo estandarizado, respectivamente) no presentó diferencias significativas. El empleo de polvo de ajo estandarizado ofrece una alternativa viable simple para la cuantificación de allicina.

Interstitial water d13C and sediment geochemistry of ODP Leg 166 sites

A review of interstitial water samples collected from Sites 1003-1007 of the Bahamas Transect along with a shore-based analysis of oxygen and carbon isotopes, minor and trace elements, and sediment chemistry are presented. Results indicate that the pore-fluid profiles in the upper 100 meters below seafloor (mbsf) are marked by shifts between 20 and 40 mbsf that are thought to be caused by changes in sediment reactivity, sedimentation rates, and the influence of strong bottom currents that have been active since the late Pliocene. Pore-fluid profiles in the lower Pliocene-Miocene sequences are dominated by diffusion and do not show significant evidence of subsurface advective flow. Deeper interstitial waters are believed to be the in situ fluids that have evolved through interaction with sediments and diffusion. Pore-fluid chemistry is strongly influenced by carbonate recrystallization processes. Increases in pore-fluid Cl- and Na+ with depth are interpreted to result mainly from carbonate remineralization reactions that are most active near the platform margin. A lateral gradient in detrital clay content observed along the transect, leads to an overall lower carbonate reactivity, and enhances preservation of metastable aragonite further away from the platform margin. Later stage burial diagenesis occurs at slow rates and is limited by the supply of reactive elements through diffusion.

Potential connections (least-cost paths) between existing and potential bison habitat patches in the Carpathian Mountains

Habitat connectivity is important for the survival of species that occupy habitat patches too small to sustain an isolated population. A prominent example of such a species is the European bison (Bison bonasus), occurring only in small, isolated herds, and whose survival will depend on establishing larger, well-connected populations. Our goal here was to assess habitat connectivity of European bison in the Carpathians. We used an existing bison habitat suitability map and data on dispersal barriers to derive cost surfaces, representing the ability of bison to move across the landscape, and to delineate potential connections (as least-cost paths) between currently occupied and potential habitat patches. Graph theory tools were then employed to evaluate the connectivity of all potential habitat patches and their relative importance in the network. Our analysis showed that existing bison herds in Ukraine are isolated. However, we identified several groups of well-connected habitat patches in the Carpathians which could host a large population of European bison. Our analysis also located important dispersal corridors connecting existing herds, and several promising locations for future reintroductions (especially in the Eastern Carpathians) that should have a high priority for conservation efforts. In general, our approach indicates the most important elements within a landscape mosaic for providing and maintaining the overall connectivity of different habitat networks and thus offers a robust and powerful tool for conservation planning.

Distribution System of China's Industrial Clusters: Case Study of Yiwu China Commodity City

This paper discusses the issue of upgrading industrial clusters from the perspective of external linkages. It is taken for granted that in most developing countries, due to the limited domestic market and poor traditional commercial networks, industrial clusters are able to upgrade only when they are involved in global value chains. However, the rise of China’s industrial clusters challenges this view. Historically, China has had a lot of industrial clusters with their own traditional commercial networks. This fact combined with its huge population resulted in the formation of a unique external linage to China’s industrial clusters after the socialist planning period ended. In concrete terms, since the 1980s, a traditional commercial institution . the transaction market . began to appear in most clusters. These markets within the clusters get connected to those in the cities due to interaction between traditional merchants and local governments. This has resulted in the formation of a powerful market network-based distribution system which has played a crucial role for China’s industrial clusters in responding to exploding domestic demand. This paper explains these features in detail, using Yiwu China Commodity City as a case study.

Segmentación de Secuencias de Vídeo: análisis y desarrollo de estrategias para la detección de cambios de toma y para la detección de objetos móviles

The important technological advances experienced along the last years have resulted in an important demand for new and efficient computer vision applications. On the one hand, the increasing use of video editing software has given rise to a necessity for faster and more efficient editing tools that, in a first step, perform a temporal segmentation in shots. On the other hand, the number of electronic devices with integrated cameras has grown enormously. These devices require new, fast, and efficient computer vision applications that include moving object detection strategies. In this dissertation, we propose a temporal segmentation strategy and several moving object detection strategies, which are suitable for the last generation of computer vision applications requiring both low computational cost and high quality results. First, a novel real-time high-quality shot detection strategy is proposed. While abrupt transitions are detected through a very fast pixel-based analysis, gradual transitions are obtained from an efficient edge-based analysis. Both analyses are reinforced with a motion analysis that allows to detect and discard false detections. This analysis is carried out exclusively over a reduced amount of candidate transitions, thus maintaining the computational requirements. On the other hand, a moving object detection strategy, which is based on the popular Mixture of Gaussians method, is proposed. This strategy, taking into account the recent history of each image pixel, adapts dynamically the amount of Gaussians that are required to model its variations. As a result, we improve significantly the computational efficiency with respect to other similar methods and, additionally, we reduce the influence of the used parameters in the results. Alternatively, in order to improve the quality of the results in complex scenarios containing dynamic backgrounds, we propose different non-parametric based moving object detection strategies that model both background and foreground. To obtain high quality results regardless of the characteristics of the analyzed sequence we dynamically estimate the most adequate bandwidth matrices for the kernels that are used in the background and foreground modeling. Moreover, the application of a particle filter allows to update the spatial information and provides a priori knowledge about the areas to analyze in the following images, enabling an important reduction in the computational requirements and improving the segmentation results. Additionally, we propose the use of an innovative combination of chromaticity and gradients that allows to reduce the influence of shadows and reflects in the detections.

Computational Schemes for Optimizing Domains of Attraction in Dynamical Systems

In this paper, several computational schemes are presented for the optimal tuning of the global behavior of nonlinear dynamical sys- tems. Specifically, the maximization of the size of domains of attraction associated with invariants in parametrized dynamical sys- tems is addressed. Cell Mapping (CM) tech- niques are used to estimate the size of the domains, and such size is then maximized via different optimization tools. First, a ge- netic algorithm is tested whose performance shows to be good for determining global maxima at the expense of high computa- tional cost. Secondly, an iterative scheme based on a Stochastic Approximation proce- dure (the Kiefer-Wolfowitz algorithm) is eval- uated showing acceptable performance at low cost. Finally, several schemes combining neu- ral network based estimations and optimiza- tion procedures are addressed with promising results. The performance of the methods is illus- trated with two applications: first on the well-known van der Pol equation with stan- dard parametrization, and second the tuning of a controller for saturated systems.

Integración Wi-Fi en un proyecto ICT

La instalación de Infraestructuras Comunes de Telecomunicación (IICCTT) en el interior de las edificaciones para el acceso a los servicios de telecomunicación facilitó la incorporación a las viviendas de las nuevas tecnologías de forma económica y transparente para los usuarios. Actualmente, todos los edificios de nueva construcción deben presentar un proyecto ICT firmado por un Ingeniero Técnico de Telecomunicación de la especialidad correspondiente o un Ingeniero de Telecomunicación. La legislación que las regula afecta a todo tipo de viviendas con independencia del poder adquisitivo del comprador, y contribuye de manera decisiva a que disminuyan a corto y medio plazo las desigualdades sociales en lo relativo al acceso a servicios de telecomunicación tales como telefonía, Internet, telecomunicación por cable, radiodifusión sonora y televisión analógica, digital, terrenal o por satélite, etc.. Desde 1997, el Colegio Oficial de Ingenieros de Telecomunicación junto con otras organizaciones públicas y privadas ha participado en la elaboración de la normativa aplicable a las Infraestructuras Comunes de Telecomunicación, dando lugar al actual decreto, el Real Decreto 346/2011, de 11 de Marzo. El propósito general de este proyecto es diseñar una red Wi-Fi a partir de las canalizaciones e instalaciones del proyecto ICT de un conjunto de viviendas unifamiliares, para que todas ellas dispongan de conexión a internet de forma inalámbrica. Para llevar a cabo este diseño, se ha realizado un estudio de las características del estándar IEEE 802.11, conocido como Wi-Fi, analizando las posibilidades de comunicación inalámbrica que ofrece, así como las limitaciones que presenta en la actualidad. Se ha analizado el proyecto ICT del conjunto de viviendas, estudiando la viabilidad de utilizar sus instalaciones para implementar la red Wi-Fi, añadiendo tanto las canalizaciones como los dispositivos comerciales necesarios para llevar a cabo dicha implementación. Además, se ha estudiado la posibilidad de integrar la red Wi-Fi utilizando el cableado de televisión de la propia ICT. Por último, se ha estudiado la gran importancia que al Hogar Digital se da en el Real Decreto 346/2011, de 11 de marzo, por el que se aprueba el Reglamento regulador de las Infraestructuras Comunes de Telecomunicaciones para el acceso a los servicios de telecomunicación en el interior de las edificaciones, presentando los aspectos fundamentales que se persiguen con la domotización de la vivienda como mejora de vida de sus habitantes. Abstract The installation of Telecommunications Common Infrastructures (TCIs, in Spanish Infraestructuras Comunes de Telecomunicación –IICCTT-) in the buildings, in order to gain access to telecommunications services, facilitated the incorporation into the houses of new technologies in an economical and transparent way for users. Nowadays, every new construction building must have a TCI project signed by a Telecommunications Engineer or a Technical Telecommunications Engineer with the appropriate specialization. The legislation that regulates TCIs affects every kind of houses, independently of the buyer´s purchasing power, and contributes decisively to decrease in short and medium terms the social inequalities concerning the access to the telecommunication services, such as telephony, Internet, wired telecommunications, audible broadcasting and digital, analogical, land, satellite television, etc.. Since 1997, the Telecommunications Engineer Official College, together with other public and private organizations, has been elaborating the regulations for the TCIs, giving rise to the current decree, the Royal Decree 346/2011, of 11th of March. The general purpose of this project is to design a Wi-Fi network based on the canalizations and installations of the TCI project of a housing development, in such a way that every house is provided with a wireless connection to the Internet. In order to carry out this design, the characteristics of the standard IEEE 802.11, known as Wi-Fi, have been studied, analyzing the wireless-communication possibilities that it offers, as well as the constraints that it presents currently. The TCI project has been analyzed, studying the feasibility of using its installations to implement the Wi-Fi network, adding the canalizations and commercial devices required to execute the aforementioned implementation. Besides, the possibility of integrating the Wi-Fi network using the television wires of the TCI project has been investigated. Finally, it has been studied the great importance that has been given to Digital Home in the Royal Decree 346/2011, of 11th of March, that approves the regulatory Regulations of Telecommunications Common Infrastructures for the access to telecommunications services inside the buildings, presenting the essential aspects that are pursued with the house domotization as a way to improve the quality of life of its inhabitants.