Optimizing Triage and Hospitalization in Adult General Medical Emergency Patients. The Triage Project

Background: Patients presenting to the emergency department (ED) currently face inacceptable delays in initial treatment, and long, costly hospital stays due to suboptimal initial triage and site-of-care decisions. Accurate ED triage should focus not only on initial treatment priority, but also on prediction of medical risk and nursing needs to improve site-of-care decisions and to simplify early discharge management. Different triage scores have been proposed, such as the Manchester triage system (MTS). Yet, these scores focus only on treatment priority, have suboptimal performance and lack validation in the Swiss health care system. Because the MTS will be introduced into clinical routine at the Kantonsspital Aarau, we propose a large prospective cohort study to optimize initial patient triage. Specifically, the aim of this trial is to derive a three-part triage algorithm to better predict (a) treatment priority; (b) medical risk and thus need for in-hospital treatment; (c) post-acute care needs of patients at the most proximal time point of ED admission. Methods/design: Prospective, observational, multicenter, multi-national cohort study. We will include all consecutive medical patients seeking ED care into this observational registry. There will be no exclusions except for non-adult and non-medical patients. Vital signs will be recorded and left over blood samples will be stored for later batch analysis of blood markers. Upon ED admission, the post-acute care discharge score (PACD) will be recorded. Attending ED physicians will adjudicate triage priority based on all available results at the time of ED discharge to the medical ward. Patients will be reassessed daily during the hospital course for medical stability and readiness for discharge from the nurses and if involved social workers perspective. To assess outcomes, data from electronic medical records will be used and all patients will be contacted 30 days after hospital admission to assess vital and functional status, re-hospitalization, satisfaction with care and quality of life measures. We aim to include between 5000 and 7000 patients over one year of recruitment to derive the three-part triage algorithm. The respective main endpoints were defined as (a) initial triage priority (high vs. low priority) adjudicated by the attending ED physician at ED discharge, (b) adverse 30 day outcome (death or intensive care unit admission) within 30 days following ED admission to assess patients risk and thus need for in-hospital treatment and (c) post acute care needs after hospital discharge, defined as transfer of patients to a post-acute care institution, for early recognition and planning of post-acute care needs. Other outcomes are time to first physician contact, time to initiation of adequate medical therapy, time to social worker involvement, length of hospital stay, reasons fordischarge delays, patient’s satisfaction with care, overall hospital costs and patients care needs after returning home. Discussion: Using a reliable initial triage system for estimating initial treatment priority, need for in-hospital treatment and post-acute care needs is an innovative and persuasive approach for a more targeted and efficient management of medical patients in the ED. The proposed interdisciplinary , multi-national project has unprecedented potential to improve initial triage decisions and optimize resource allocation to the sickest patients from admission to discharge. The algorithms derived in this study will be compared in a later randomized controlled trial against a usual care control group in terms of resource use, length of hospital stay, overall costs and patient’s outcomes in terms of mortality, re-hospitalization, quality of life and satisfaction with care.

Land acquisition, investment, and development in the Lao coffee sector: Successes and failures

Despite the increasing acknowledgment of scholars and practitioners that many large-scale agricultural land acquisitions in developing countries fail or never materialize, empirical evidence about how and why they fail to date is still scarce. Too often, land deals are portrayed as straightforward investments and their success is taken for granted. Looking at the coffee sector in Laos, the authors of this article explore dimensions of the land grab debate that have not yet been sufficiently examined. Coffee concessionaires in southern Laos often fail to use all of the land granted them and fail to produce high yields on the land they do use. Thus, the authors challenge the often-assumed superiority and effectiveness of large-scale versus small-scale production, specifically the argument that they modernize agricultural production and optimize land use. They argue that examining failed investments is as important as studying successful ones for understanding the implications of the land grabbing phenomenon for social, economic, and environmental outcomes. Knowledge about the scale of “failed land deals” provides important motivation for national governments to close the gap between intentions and actual outcomes. This article engages with the current debate on quality of investment and challenges the approach of employing land concessions as a vehicle for economic development in the Lao coffee sector and in other sectors and countries.

Intracoronary imaging of coronary atherosclerosis: validation for diagnosis, prognosis and treatment.

While coronary atherosclerosis is a leading cause of mortality, evaluation of coronary lesions was previously limited to either indirect angiographic assessment of the lumen silhouette or post mortem investigations. Intracoronary (IC) imaging modalities have been developed that allow for visualization and characterization of coronary atheroma in living patients. Used alone or in combination, these modalities have enhanced our understanding of pathobiological mechanisms of atherosclerosis, identified factors responsible for disease progression, and documented the ability of various medications to reverse the processes of plaque growth and destabilization. These methodologies have established a link between in vivo plaque characteristics and subsequent coronary events, thereby improving individual risk stratification, paving the way for risk-tailored systemic therapies and raising the option for pre-emptive interventions. Moreover, IC imaging is increasingly used during coronary interventions to support therapeutic decision-making in angiographically inconclusive disease, guide and optimize procedural results in selected lesion and patient subsets, and unravel mechanisms underlying stent failure. This review aims to summarize current evidence regarding the role of IC imaging for diagnosis and risk stratification of coronary atherosclerosis, and to describe its clinical role for guiding percutaneous coronary interventions. Future perspectives for in-depth plaque characterization using novel techniques and multimodality imaging approaches are also discussed.

Spine radiography in the evaluation of back and neck pain in an orthopaedic emergency clinic

BACKGROUND AND OBJECTIVES Despite the recommendations of national and international societies for the treatment of patients with acute neck and back pain, still too many radiologic examinations were performed. The purpose of this study was to analyze and optimize diagnostics and treatment of patients with acute back pain. METHODS The medical records of 484 patients presented to the emergency clinic with acute neck or back pain were analyzed for clinical history, physical examination, radiographic findings and therapy. RESULTS Radiographs of the lumbar, cervical, or thoracic spine were performed in 338 cases (70%). Radiographs were normal in 142 patients (42%) and degenerative changes were identified in 123 patients (36%). Only 2 patients (0.4%) had radiographic findings that had direct therapeutic relevance: 1 patient with metastatic disease and 1 patient with posttraumatic C1-C2 instability. For most patients without sensorimotor deficits and absent specific indications for radiography (“red flags”), therapy was not affected by the results of radiography. CONCLUSIONS Plain radiography of the spine was unnecessary in most patients initially evaluated with non-specific acute back pain and does not improve the clinical outcome. The implementation of national and international guidelines is a slow process, but helps to reduce costs and to protect patients from unnecessary ionizing radiation exposure.

Cone beam computed tomography (CBCT) for diagnosis and treatment planning in periodontology: A systematic review.

OBJECTIVE The improvement in diagnostic accuracy and optimization of treatment planning in periodontology through the use of three-dimensional imaging with cone beam computed tomography (CBCT) is discussed controversially in the literature. The objective was to identify the best available external evidence for the indications of CBCT for periodontal diagnosis and treatment planning in specific clinical situations. DATA SOURCES A systematic literature search was performed for articles published by 2 March 2015 using electronic databases and hand search. Two reviewers performed the study selection, data collection, and validity assessment. PICO and PRISMA criteria were applied. From the combined search, seven studies were finally included. CONCLUSION The case series were published from the years 2009 to 2014. Five of the included publications refer to maxillary and/or mandibular molars and two to aspects related to vertical bony defects. Two studies show a high accuracy of CBCT in detecting intrabony defect morphology when compared to periapical radiographs. Particularly, in maxillary molars, CBCT provides high accuracy for detecting furcation involvement and morphology of surrounding periodontal tissues. CBCT has demonstrated advantages, when more invasive treatment approaches were considered in terms of decision making and cost benefit. Within their limits, the available data suggest that CBCT may improve diagnostic accuracy and optimize treatment planning in periodontal defects, particularly in maxillary molars with furcation involvement, and that the higher irradiation doses and cost-benefit ratio should be carefully analyzed before using CBCT for periodontal diagnosis and treatment planning.

NOVEL PHANTOMS AND POST-PROCESSING FOR DIFFUSION SPECTRUM IMAGING

High Angular Resolution Diffusion Imaging (HARDI) techniques, including Diffusion Spectrum Imaging (DSI), have been proposed to resolve crossing and other complex fiber architecture in the human brain white matter. In these methods, directional information of diffusion is inferred from the peaks in the orientation distribution function (ODF). Extensive studies using histology on macaque brain, cat cerebellum, rat hippocampus and optic tracts, and bovine tongue are qualitatively in agreement with the DSI-derived ODFs and tractography. However, there are only two studies in the literature which validated the DSI results using physical phantoms and both these studies were not performed on a clinical MRI scanner. Also, the limited studies which optimized DSI in a clinical setting, did not involve a comparison against physical phantoms. Finally, there is lack of consensus on the necessary pre- and post-processing steps in DSI; and ground truth diffusion fiber phantoms are not yet standardized. Therefore, the aims of this dissertation were to design and construct novel diffusion phantoms, employ post-processing techniques in order to systematically validate and optimize (DSI)-derived fiber ODFs in the crossing regions on a clinical 3T MR scanner, and develop user-friendly software for DSI data reconstruction and analysis. Phantoms with a fixed crossing fiber configuration of two crossing fibers at 90° and 45° respectively along with a phantom with three crossing fibers at 60°, using novel hollow plastic capillaries and novel placeholders, were constructed. T2-weighted MRI results on these phantoms demonstrated high SNR, homogeneous signal, and absence of air bubbles. Also, a technique to deconvolve the response function of an individual peak from the overall ODF was implemented, in addition to other DSI post-processing steps. This technique greatly improved the angular resolution of the otherwise unresolvable peaks in a crossing fiber ODF. The effects of DSI acquisition parameters and SNR on the resultant angular accuracy of DSI on the clinical scanner were studied and quantified using the developed phantoms. With a high angular direction sampling and reasonable levels of SNR, quantification of a crossing region in the 90°, 45° and 60° phantoms resulted in a successful detection of angular information with mean ± SD of 86.93°±2.65°, 44.61°±1.6° and 60.03°±2.21° respectively, while simultaneously enhancing the ODFs in regions containing single fibers. For the applicability of these validated methodologies in DSI, improvement in ODFs and fiber tracking from known crossing fiber regions in normal human subjects were demonstrated; and an in-house software package in MATLAB which streamlines the data reconstruction and post-processing for DSI, with easy to use graphical user interface was developed. In conclusion, the phantoms developed in this dissertation offer a means of providing ground truth for validation of reconstruction and tractography algorithms of various diffusion models (including DSI). Also, the deconvolution methodology (when applied as an additional DSI post-processing step) significantly improved the angular accuracy of the ODFs obtained from DSI, and should be applicable to ODFs obtained from the other high angular resolution diffusion imaging techniques.

Use of Echogenic Immunoliposomes for Delivery of both Drug and Stem Cells for Inhibition of Atheroma Progression

Use of Echogenic Immunoliposomes for Delivery of both Drug and Stem Cells for Inhibition of Atheroma Progression By Ali K. Naji B.S. Advisor: Dr. Melvin E. Klegerman PhD Background and significance: Echogenic liposomes can be used as drug and cell delivery vehicles that reduce atheroma progression. Vascular endothelial growth factor (VEGF) is a signal protein that induces vasculogenesis and angiogenesis. VEGF functionally induces migration and proliferation of endothelial cells and increases intracellular vascular permeability. VEGF activates angiogenic transduction factors through VEGF tyrosine kinase domains in high-affinity receptors of endothelial cells. Bevacizumab is a humanized monoclonal antibody specific for VEGF-A which was developed as an anti-tumor agent. Often, anti-VEGF agents result in regression of existing microvessels, inhibiting tumor growth and possibly causing tumor shrinkage with time. During atheroma progression neovasculation in the arterial adventitia is mediated by VEGF. Therefore, bevacizumab may be effective in inhibiting atheroma progression. Stem cells show an ability to inhibit atheroma progression. We have previously demonstrated that monocyte derived CD-34+ stem cells that can be delivered to atheroma by bifunctional-ELIP ( BF-ELIP) targeted to Intercellular Adhesion Molecule-1 (ICAM-1) and CD-34. Adhesion molecules such as ICAM-1 and vascular cell adhesion molecule-1 (VCAM-1) are expressed by endothelial cells under inflammatory conditions. Ultrasound enhanced liposomal targeting provides a method for stem cell delivery into atheroma and encapsulated drug release. This project is designed to examine the ability of echogenic liposomes to deliver bevacizumab and stem cells to inhibit atheroma progression and neovasculation with and without ultrasound in vitro and optimize the ultrasound parameters for delivery of bevacizumab and stem cells to atheroma. V Hypotheses: Previous studies showed that endothelial cell VEGF expression may relate to atherosclerosis progression and atheroma formation in the cardiovascular system. Bevacizumab-loaded ELIP will inhibit endothelial cell VEGF expression in vitro. Bevacizumab activity can be enhanced by pulsed Doppler ultrasound treatment of BEV-ELIP. I will also test the hypothesis that the transwell culture system can serve as an in vitro model for study of US-enhanced targeted delivery of stem cells to atheroma. Monocyte preparations will serve as a source of CD34+ stem cells. Specific Aims: Induce VEGF expression using PKA and PKC activation factors to endothelial cell cultures and use western blot and ELISA techniques to detect the expressed VEGF.  Characterize the relationship between endothelial cell proliferation and VEGF expression to develop a specific EC culture based system to demonstrate BEV-ELIP activity as an anti-VEGF agent. Design a cell-based assay for in vitro assessment of ultrasound-enhanced bevacizumab release from echogenic liposomes.  Demonstrate ultrasound delivery enhancement of stem cells by applying different types of liposomes on transwell EC culture using fluorescently labeled monocytes and detect the effect on migration and attachment rate of these echogenic liposomes with and without ultrasound in vitro.

Implementation and development in OJS of the Scientific Journals Site of the Facultad de Humanidades y Ciencias de la Educación of the Universidad Nacional de La Plata

Nuestro objetivo es compartir la experiencia de implementación y desarrollo en OJS del Portal de Revistas Científicas de la Facultad de Humanidades y Ciencias de la Educación (FaHCE) de la Universidad Nacional de La Plata (UNLP) a través del cual se publican en acceso abierto, bajo licencias Creative Commons, las revistas científicas de esta Unidad Académica, incluyendo tanto las electrónicas como las versiones digitales de las de formato papel. El proyecto Portal de Revistas, inaugurado en diciembre de 2012, a cargo del Area de Publicaciones, logró unificar el acceso a las revistas de la institución que integran el Núcleo Básico de Revistas Científicas Argentinas (CAICYT-CONICET). Su objetivo es facilitar la gestión editorial, el cumplimiento de la periodicidad y de los parámetros de evaluación sugeridos por las bases de datos regionales e internacionales y la automatización de los envíos a bases de datos para aumentar su visibilidad optimizando los tiempos de trabajo

Implementation and development in OJS of the Scientific Journals Site of the Facultad de Humanidades y Ciencias de la Educación of the Universidad Nacional de La Plata

Nuestro objetivo es compartir la experiencia de implementación y desarrollo en OJS del Portal de Revistas Científicas de la Facultad de Humanidades y Ciencias de la Educación (FaHCE) de la Universidad Nacional de La Plata (UNLP) a través del cual se publican en acceso abierto, bajo licencias Creative Commons, las revistas científicas de esta Unidad Académica, incluyendo tanto las electrónicas como las versiones digitales de las de formato papel. El proyecto Portal de Revistas, inaugurado en diciembre de 2012, a cargo del Area de Publicaciones, logró unificar el acceso a las revistas de la institución que integran el Núcleo Básico de Revistas Científicas Argentinas (CAICYT-CONICET). Su objetivo es facilitar la gestión editorial, el cumplimiento de la periodicidad y de los parámetros de evaluación sugeridos por las bases de datos regionales e internacionales y la automatización de los envíos a bases de datos para aumentar su visibilidad optimizando los tiempos de trabajo

Implementation and development in OJS of the Scientific Journals Site of the Facultad de Humanidades y Ciencias de la Educación of the Universidad Nacional de La Plata

Nuestro objetivo es compartir la experiencia de implementación y desarrollo en OJS del Portal de Revistas Científicas de la Facultad de Humanidades y Ciencias de la Educación (FaHCE) de la Universidad Nacional de La Plata (UNLP) a través del cual se publican en acceso abierto, bajo licencias Creative Commons, las revistas científicas de esta Unidad Académica, incluyendo tanto las electrónicas como las versiones digitales de las de formato papel. El proyecto Portal de Revistas, inaugurado en diciembre de 2012, a cargo del Area de Publicaciones, logró unificar el acceso a las revistas de la institución que integran el Núcleo Básico de Revistas Científicas Argentinas (CAICYT-CONICET). Su objetivo es facilitar la gestión editorial, el cumplimiento de la periodicidad y de los parámetros de evaluación sugeridos por las bases de datos regionales e internacionales y la automatización de los envíos a bases de datos para aumentar su visibilidad optimizando los tiempos de trabajo

Contents of Ag, Bi, In, and Tl in suspended and aerosol matter at Station DM8-579 in the Peru Basin, Southeast Pacific

A new electrothermal atomizer for use in direct determination of Ag, Bi, In, and Tl in marine, riverine, and aeolian particulate matter on membrane filters is described. A sample capsule and atomization cell are heated separately. That is why it is possible to separate and optimize decomposition of a sample, vaporization of elements and atomization of their vapors. Noise reduction and design, which localizes the vapors in a light absorption zone, decrease detection limits of these four elements by factor of at least 3 to 10. Some analytical results are given.

Continuous multi-criteria methods for crop and soil conservation planning on La Colacha (Río Cuarto, Province of Cordoba, Argentina)

Agro-areas of Arroyos Menores (La Colacha) west and south of Rand south of R?o Cuarto (Prov. of Cordoba, Argentina) basins are very fertile but have high soil loses. Extreme rain events, inundations and other severe erosions forming gullies demand urgently actions in this area to avoid soil degradation and erosion supporting good levels of agro production. The authors first improved hydrologic data on La Colacha, evaluated the systems of soil uses and actions that could be recommended considering the relevant aspects of the study area and applied decision support systems (DSS) with mathematic tools for planning of defences and uses of soils in these areas. These were conducted here using multi-criteria models, in multi-criteria decision making (MCDM); first of discrete MCDM to chose among global types of use of soils, and then of continuous MCDM to evaluate and optimize combined actions, including repartition of soil use and the necessary levels of works for soil conservation and for hydraulic management to conserve against erosion these basins. Relatively global solutions for La Colacha area have been defined and were optimised by Linear Programming in Goal Programming forms that are presented as Weighted or Lexicographic Goal Programming and as Compromise Programming. The decision methods used are described, indicating algorithms used, and examples for some representative scenarios on La Colacha area are given.

Efficient design and optimization of bio-photonic sensing cells (BICELLs) for label free biosensing

In previous works we demonstrated the benefits of using micro–nano patterning materials to be used as bio-photonic sensing cells (BICELLs), referred as micro–nano photonic structures having immobilized bioreceptors on its surface with the capability of recognizing the molecular binding by optical transduction. Gestrinone/anti-gestrinone and BSA/anti-BSA pairs were proven under different optical configurations to experimentally validate the biosensing capability of these bio-sensitive photonic architectures. Moreover, Three-Dimensional Finite Difference Time Domain (FDTD) models were employed for simulating the optical response of these structures. For this article, we have developed an effective analytical simulation methodology capable of simulating complex biophotonic sensing architectures. This simulation method has been tested and compared with previous experimental results and FDTD models. Moreover, this effective simulation methodology can be used for efficiently design and optimize any structure as BICELL. In particular for this article, six different BICELL's types have been optimized. To carry out this optimization we have considered three figures of merit: optical sensitivity, Q-factor and signal amplitude. The final objective of this paper is not only validating a suitable and efficient optical simulation methodology but also demonstrating the capability of this method for analyzing the performance of a given number of BICELLs for label-free biosensing.

Design and optimization of optical, fiber based PSK demodulators for high-bit-rate optical networks

El objetivo principal de esta tesis ha sido el diseño y la optimización de receptores implementados con fibra óptica, para ser usados en redes ópticas de alta velocidad que empleen formatos de modulación de fase. En los últimos años, los formatos de modulación de fase (Phase Shift keying, PSK) han captado gran atención debido a la mejora de sus prestaciones respecto a los formatos de modulación convencionales. Principalmente, presentan una mejora de la eficiencia espectral y una mayor tolerancia a la degradación de la señal causada por la dispersión cromática, la dispersión por modo de polarización y los efectos no-lineales en la fibra óptica. En este trabajo, se analizan en detalle los formatos PSK, incluyendo sus variantes de modulación de fase diferencial (Differential Phase Shift Keying, DPSK), en cuadratura (Differential Quadrature Phase Shift Keying, DQPSK) y multiplexación en polarización (Polarization Multiplexing Differential Quadrature Phase Shift Keying, PM-DQPSK), con la finalidad de diseñar y optimizar los receptores que permita su demodulación. Para ello, se han analizado y desarrollado nuevas estructuras que ofrecen una mejora en las prestaciones del receptor y una reducción de coste comparadas con las actualmente disponibles. Para la demodulación de señales DPSK, en esta tesis, se proponen dos nuevos receptores basados en un interferómetro en línea Mach-Zehnder (MZI) implementado con tecnología todo-fibra. El principio de funcionamiento de los MZI todo-fibra propuestos se asienta en la interferencia modal que se produce en una fibra multimodo (MMF) cuando se situada entre dos monomodo (SMF). Este tipo de configuración (monomodo-multimodo-monomodo, SMS) presenta un buen ratio de extinción interferente si la potencia acoplada en la fibra multimodo se reparte, principal y equitativamente, entre dos modos dominantes. Con este objetivo, se han estudiado y demostrado tanto teórica como experimentalmente dos nuevas estructuras SMS que mejoran el ratio de extinción. Una de las propuestas se basa en emplear una fibra multimodo de índice gradual cuyo perfil del índice de refracción presenta un hundimiento en su zona central. La otra consiste en una estructura SMS con las fibras desalineadas y donde la fibra multimodo es una fibra de índice gradual convencional. Para las dos estructuras, mediante el análisis teórico desarrollado, se ha demostrado que el 80 – 90% de la potencia de entrada se acopla a los dos modos dominantes de la fibra multimodo y se consigue una diferencia inferior al 10% entre ellos. También se ha demostrado experimentalmente que se puede obtener un ratio de extinción de al menos 12 dB. Con el objeto de demostrar la capacidad de estas estructuras para ser empleadas como demoduladores de señales DPSK, se han realizado numerosas simulaciones de un sistema de transmisión óptico completo y se ha analizado la calidad del receptor bajo diferentes perspectivas, tales como la sensibilidad, la tolerancia a un filtrado óptico severo o la tolerancia a las dispersiones cromática y por modo de polarización. En todos los casos se ha concluido que los receptores propuestos presentan rendimientos comparables a los obtenidos con receptores convencionales. En esta tesis, también se presenta un diseño alternativo para la implementación de un receptor DQPSK, basado en el uso de una fibra mantenedora de la polarización (PMF). A través del análisi teórico y del desarrollo de simulaciones numéricas, se ha demostrado que el receptor DQPSK propuesto presenta prestaciones similares a los convencionales. Para complementar el trabajo realizado sobre el receptor DQPSK basado en PMF, se ha extendido el estudio de su principio de demodulación con el objeto de demodular señales PM-DQPSK, obteniendo como resultado la propuesta de una nueva estructura de demodulación. El receptor PM-DQPSK propuesto se basa en la estructura conjunta de una única línea de retardo junto con un rotador de polarización. Se ha analizado la calidad de los receptores DQPSK y PM-DQPSK bajo diferentes perspectivas, tales como la sensibilidad, la tolerancia a un filtrado óptico severo, la tolerancia a las dispersiones cromática y por modo de polarización o su comportamiento bajo condiciones no-ideales. En comparación con los receptores convencionales, nuestra propuesta exhibe prestaciones similares y además permite un diseño más simple que redunda en un coste potencialmente menor. En las redes de comunicaciones ópticas actuales se utiliza la tecnología de multimplexación en longitud de onda (WDM) que obliga al uso de filtros ópticos con bandas de paso lo más estrechas posibles y a emplear una serie de dispositivos que incorporan filtros en su arquitectura, tales como los multiplexores, demultiplexores, ROADMs, conmutadores y OXCs. Todos estos dispositivos conectados entre sí son equivalentes a una cadena de filtros cuyo ancho de banda se va haciendo cada vez más estrecho, llegando a distorsionar la forma de onda de las señales. Por esto, además de analizar el impacto del filtrado óptico en las señales de 40 Gbps DQPSK y 100 Gbps PM-DQPSK, este trabajo de tesis se completa estudiando qué tipo de filtro óptico minimiza las degradaciones causadas en la señal y analizando el número máximo de filtros concatenados que permiten mantener la calidad requerida al sistema. Se han estudiado y simulado cuatro tipos de filtros ópticos;Butterworth, Bessel, FBG y F-P. ABSTRACT The objective of this thesis is the design and optimization of optical fiber-based phase shift keying (PSK) demodulators for high-bit-rate optical networks. PSK modulation formats have attracted significant attention in recent years, because of the better performance with respect to conventional modulation formats. Principally, PSK signals can improve spectrum efficiency and tolerate more signal degradation caused by chromatic dispersion, polarization mode dispersion and nonlinearities in the fiber. In this work, many PSK formats were analyzed in detail, including the variants of differential phase modulation (Differential Phase Shift Keying, DPSK), in quadrature (Differential Quadrature Phase Shift Keying, DQPSK) and polarization multiplexing (Polarization Multiplexing Differential Quadrature Phase Shift Keying, PM-DQPSK), in order to design and optimize receivers enabling demodulations. Therefore, novel structures, which offer good receiver performances and a reduction in cost compared to the current structures, have been analyzed and developed. Two novel receivers based on an all-fiber in-line Mach-Zehnder interferometer (MZI) were proposed for DPSK signal demodulation in this thesis. The operating principle of the all-fiber MZI is based on the modal interference that occurs in a multimode fiber (MMF) when it is located between two single-mode fibers (SMFs). This type of configuration (Single-mode-multimode-single-mode, SMS) can provide a good extinction ratio if the incoming power from the SMF could be coupled equally into two dominant modes excited in the MMF. In order to improve the interference extinction ratio, two novel SMS structures have been studied and demonstrated, theoretically and experimentally. One of the two proposed MZIs is based on a graded-index multimode fiber (MMF) with a central dip in the index profile, located between two single-mode fibers (SMFs). The other one is based on a conventional graded-index MMF mismatch spliced between two SMFs. Theoretical analysis has shown that, in these two schemes, 80 – 90% of the incoming power can be coupled into the two dominant modes exited in the MMF, and the power difference between them is only ~10%. Experimental results show that interference extinction ratio of 12 dB could be obtained. In order to demonstrate the capacity of these two structures for use as DPSK signal demodulators, numerical simulations in a completed optical transmission system have been carried out, and the receiver quality has been analyzed under different perspectives, such as sensitivity, tolerance to severe optical filtering or tolerance to chromatic and polarization mode dispersion. In all cases, from the simulation results we can conclude that the two proposed receivers can provide performances comparable to conventional ones. In this thesis, an alternative design for the implementation of a DQPSK receiver, which is based on a polarization maintaining fiber (PMF), was also presented. To complement the work made for the PMF-based DQPSK receiver, the study of the demodulation principle has been extended to demodulate PM-DQPSK signals, resulting in the proposal of a novel demodulation structure. The proposed PM-DQPSK receiver is based on only one delay line and a polarization rotator. The quality of the proposed DQPSK and PM-DQPSK receivers under different perspectives, such as sensitivity, tolerance to severe optical filtering, tolerance to chromatic dispersion and polarization mode dispersion, or behavior under non-ideal conditions. Compared with the conventional receivers, our proposals exhibit similar performances but allow a simpler design which can potentially reduce the cost. The wavelength division multiplexing (WDM) technology used in current optical communications networks requires the use of optical filters with a passband as narrow as possible, and the use of a series of devices that incorporate filters in their architecture, such as multiplexers, demultiplexers, switches, reconfigurable add-drop multiplexers (ROADMs) and optical cross-connects (OXCs). All these devices connected together are equivalent to a chain of filters whose bandwidth becomes increasingly narrow, resulting in distortion to the waveform of the signals. Therefore, in addition to analyzing the impact of optical filtering on signal of 40 Gbps DQPSK and 100 Gbps PM-DQPSK, we study which kind of optical filter minimizes the signal degradation and analyze the maximum number of concatenated filters for maintaining the required quality of the system. Four types of optical filters, including Butterworth, Bessel, FBG and FP, have studied and simulated.

Trust-ware: A Methodology to Analyze, Design, and Secure Trust and Reputation Systems

Entendemos por inteligencia colectiva una forma de inteligencia que surge de la colaboración y la participación de varios individuos o, siendo más estrictos, varias entidades. En base a esta sencilla definición podemos observar que este concepto es campo de estudio de las más diversas disciplinas como pueden ser la sociología, las tecnologías de la información o la biología, atendiendo cada una de ellas a un tipo de entidades diferentes: seres humanos, elementos de computación o animales. Como elemento común podríamos indicar que la inteligencia colectiva ha tenido como objetivo el ser capaz de fomentar una inteligencia de grupo que supere a la inteligencia individual de las entidades que lo forman a través de mecanismos de coordinación, cooperación, competencia, integración, diferenciación, etc. Sin embargo, aunque históricamente la inteligencia colectiva se ha podido desarrollar de forma paralela e independiente en las distintas disciplinas que la tratan, en la actualidad, los avances en las tecnologías de la información han provocado que esto ya no sea suficiente. Hoy en día seres humanos y máquinas a través de todo tipo de redes de comunicación e interfaces, conviven en un entorno en el que la inteligencia colectiva ha cobrado una nueva dimensión: ya no sólo puede intentar obtener un comportamiento superior al de sus entidades constituyentes sino que ahora, además, estas inteligencias individuales son completamente diferentes unas de otras y aparece por lo tanto el doble reto de ser capaces de gestionar esta gran heterogeneidad y al mismo tiempo ser capaces de obtener comportamientos aún más inteligentes gracias a las sinergias que los distintos tipos de inteligencias pueden generar. Dentro de las áreas de trabajo de la inteligencia colectiva existen varios campos abiertos en los que siempre se intenta obtener unas prestaciones superiores a las de los individuos. Por ejemplo: consciencia colectiva, memoria colectiva o sabiduría colectiva. Entre todos estos campos nosotros nos centraremos en uno que tiene presencia en la práctica totalidad de posibles comportamientos inteligentes: la toma de decisiones. El campo de estudio de la toma de decisiones es realmente amplio y dentro del mismo la evolución ha sido completamente paralela a la que citábamos anteriormente en referencia a la inteligencia colectiva. En primer lugar se centró en el individuo como entidad decisoria para posteriormente desarrollarse desde un punto de vista social, institucional, etc. La primera fase dentro del estudio de la toma de decisiones se basó en la utilización de paradigmas muy sencillos: análisis de ventajas e inconvenientes, priorización basada en la maximización de algún parámetro del resultado, capacidad para satisfacer los requisitos de forma mínima por parte de las alternativas, consultas a expertos o entidades autorizadas o incluso el azar. Sin embargo, al igual que el paso del estudio del individuo al grupo supone una nueva dimensión dentro la inteligencia colectiva la toma de decisiones colectiva supone un nuevo reto en todas las disciplinas relacionadas. Además, dentro de la decisión colectiva aparecen dos nuevos frentes: los sistemas de decisión centralizados y descentralizados. En el presente proyecto de tesis nos centraremos en este segundo, que es el que supone una mayor atractivo tanto por las posibilidades de generar nuevo conocimiento y trabajar con problemas abiertos actualmente así como en lo que respecta a la aplicabilidad de los resultados que puedan obtenerse. Ya por último, dentro del campo de los sistemas de decisión descentralizados existen varios mecanismos fundamentales que dan lugar a distintas aproximaciones a la problemática propia de este campo. Por ejemplo el liderazgo, la imitación, la prescripción o el miedo. Nosotros nos centraremos en uno de los más multidisciplinares y con mayor capacidad de aplicación en todo tipo de disciplinas y que, históricamente, ha demostrado que puede dar lugar a prestaciones muy superiores a otros tipos de mecanismos de decisión descentralizados: la confianza y la reputación. Resumidamente podríamos indicar que confianza es la creencia por parte de una entidad que otra va a realizar una determinada actividad de una forma concreta. En principio es algo subjetivo, ya que la confianza de dos entidades diferentes sobre una tercera no tiene porqué ser la misma. Por otro lado, la reputación es la idea colectiva (o evaluación social) que distintas entidades de un sistema tiene sobre otra entidad del mismo en lo que respecta a un determinado criterio. Es por tanto una información de carácter colectivo pero única dentro de un sistema, no asociada a cada una de las entidades del sistema sino por igual a todas ellas. En estas dos sencillas definiciones se basan la inmensa mayoría de sistemas colectivos. De hecho muchas disertaciones indican que ningún tipo de organización podría ser viable de no ser por la existencia y la utilización de los conceptos de confianza y reputación. A partir de ahora, a todo sistema que utilice de una u otra forma estos conceptos lo denominaremos como sistema de confianza y reputación (o TRS, Trust and Reputation System). Sin embargo, aunque los TRS son uno de los aspectos de nuestras vidas más cotidianos y con un mayor campo de aplicación, el conocimiento que existe actualmente sobre ellos no podría ser más disperso. Existen un gran número de trabajos científicos en todo tipo de áreas de conocimiento: filosofía, psicología, sociología, economía, política, tecnologías de la información, etc. Pero el principal problema es que no existe una visión completa de la confianza y reputación en su sentido más amplio. Cada disciplina focaliza sus estudios en unos aspectos u otros dentro de los TRS, pero ninguna de ellas trata de explotar el conocimiento generado en el resto para mejorar sus prestaciones en su campo de aplicación concreto. Aspectos muy detallados en algunas áreas de conocimiento son completamente obviados por otras, o incluso aspectos tratados por distintas disciplinas, al ser estudiados desde distintos puntos de vista arrojan resultados complementarios que, sin embargo, no son aprovechados fuera de dichas áreas de conocimiento. Esto nos lleva a una dispersión de conocimiento muy elevada y a una falta de reutilización de metodologías, políticas de actuación y técnicas de una disciplina a otra. Debido su vital importancia, esta alta dispersión de conocimiento se trata de uno de los principales problemas que se pretenden resolver con el presente trabajo de tesis. Por otro lado, cuando se trabaja con TRS, todos los aspectos relacionados con la seguridad están muy presentes ya que muy este es un tema vital dentro del campo de la toma de decisiones. Además también es habitual que los TRS se utilicen para desempeñar responsabilidades que aportan algún tipo de funcionalidad relacionada con el mundo de la seguridad. Por último no podemos olvidar que el acto de confiar está indefectiblemente unido al de delegar una determinada responsabilidad, y que al tratar estos conceptos siempre aparece la idea de riesgo, riesgo de que las expectativas generadas por el acto de la delegación no se cumplan o se cumplan de forma diferente. Podemos ver por lo tanto que cualquier sistema que utiliza la confianza para mejorar o posibilitar su funcionamiento, por su propia naturaleza, es especialmente vulnerable si las premisas en las que se basa son atacadas. En este sentido podemos comprobar (tal y como analizaremos en más detalle a lo largo del presente documento) que las aproximaciones que realizan las distintas disciplinas que tratan la violación de los sistemas de confianza es de lo más variado. únicamente dentro del área de las tecnologías de la información se ha intentado utilizar alguno de los enfoques de otras disciplinas de cara a afrontar problemas relacionados con la seguridad de TRS. Sin embargo se trata de una aproximación incompleta y, normalmente, realizada para cumplir requisitos de aplicaciones concretas y no con la idea de afianzar una base de conocimiento más general y reutilizable en otros entornos. Con todo esto en cuenta, podemos resumir contribuciones del presente trabajo de tesis en las siguientes. • La realización de un completo análisis del estado del arte dentro del mundo de la confianza y la reputación que nos permite comparar las ventajas e inconvenientes de las diferentes aproximación que se realizan a estos conceptos en distintas áreas de conocimiento. • La definición de una arquitectura de referencia para TRS que contempla todas las entidades y procesos que intervienen en este tipo de sistemas. • La definición de un marco de referencia para analizar la seguridad de TRS. Esto implica tanto identificar los principales activos de un TRS en lo que respecta a la seguridad, así como el crear una tipología de posibles ataques y contramedidas en base a dichos activos. • La propuesta de una metodología para el análisis, el diseño, el aseguramiento y el despliegue de un TRS en entornos reales. Adicionalmente se exponen los principales tipos de aplicaciones que pueden obtenerse de los TRS y los medios para maximizar sus prestaciones en cada una de ellas. • La generación de un software que permite simular cualquier tipo de TRS en base a la arquitectura propuesta previamente. Esto permite evaluar las prestaciones de un TRS bajo una determinada configuración en un entorno controlado previamente a su despliegue en un entorno real. Igualmente es de gran utilidad para evaluar la resistencia a distintos tipos de ataques o mal-funcionamientos del sistema. Además de las contribuciones realizadas directamente en el campo de los TRS, hemos realizado aportaciones originales a distintas áreas de conocimiento gracias a la aplicación de las metodologías de análisis y diseño citadas con anterioridad. • Detección de anomalías térmicas en Data Centers. Hemos implementado con éxito un sistema de deteción de anomalías térmicas basado en un TRS. Comparamos la detección de prestaciones de algoritmos de tipo Self-Organized Maps (SOM) y Growing Neural Gas (GNG). Mostramos como SOM ofrece mejores resultados para anomalías en los sistemas de refrigeración de la sala mientras que GNG es una opción más adecuada debido a sus tasas de detección y aislamiento para casos de anomalías provocadas por una carga de trabajo excesiva. • Mejora de las prestaciones de recolección de un sistema basado en swarm computing y odometría social. Gracias a la implementación de un TRS conseguimos mejorar las capacidades de coordinación de una red de robots autónomos distribuidos. La principal contribución reside en el análisis y la validación de las mejoras increméntales que pueden conseguirse con la utilización apropiada de la información existente en el sistema y que puede ser relevante desde el punto de vista de un TRS, y con la implementación de algoritmos de cálculo de confianza basados en dicha información. • Mejora de la seguridad de Wireless Mesh Networks contra ataques contra la integridad, la confidencialidad o la disponibilidad de los datos y / o comunicaciones soportadas por dichas redes. • Mejora de la seguridad de Wireless Sensor Networks contra ataques avanzamos, como insider attacks, ataques desconocidos, etc. Gracias a las metodologías presentadas implementamos contramedidas contra este tipo de ataques en entornos complejos. En base a los experimentos realizados, hemos demostrado que nuestra aproximación es capaz de detectar y confinar varios tipos de ataques que afectan a los protocoles esenciales de la red. La propuesta ofrece unas velocidades de detección muy altas así como demuestra que la inclusión de estos mecanismos de actuación temprana incrementa significativamente el esfuerzo que un atacante tiene que introducir para comprometer la red. Finalmente podríamos concluir que el presente trabajo de tesis supone la generación de un conocimiento útil y aplicable a entornos reales, que nos permite la maximización de las prestaciones resultantes de la utilización de TRS en cualquier tipo de campo de aplicación. De esta forma cubrimos la principal carencia existente actualmente en este campo, que es la falta de una base de conocimiento común y agregada y la inexistencia de una metodología para el desarrollo de TRS que nos permita analizar, diseñar, asegurar y desplegar TRS de una forma sistemática y no artesanal y ad-hoc como se hace en la actualidad. ABSTRACT By collective intelligence we understand a form of intelligence that emerges from the collaboration and competition of many individuals, or strictly speaking, many entities. Based on this simple definition, we can see how this concept is the field of study of a wide range of disciplines, such as sociology, information science or biology, each of them focused in different kinds of entities: human beings, computational resources, or animals. As a common factor, we can point that collective intelligence has always had the goal of being able of promoting a group intelligence that overcomes the individual intelligence of the basic entities that constitute it. This can be accomplished through different mechanisms such as coordination, cooperation, competence, integration, differentiation, etc. Collective intelligence has historically been developed in a parallel and independent way among the different disciplines that deal with it. However, this is not enough anymore due to the advances in information technologies. Nowadays, human beings and machines coexist in environments where collective intelligence has taken a new dimension: we yet have to achieve a better collective behavior than the individual one, but now we also have to deal with completely different kinds of individual intelligences. Therefore, we have a double goal: being able to deal with this heterogeneity and being able to get even more intelligent behaviors thanks to the synergies that the different kinds of intelligence can generate. Within the areas of collective intelligence there are several open topics where they always try to get better performances from groups than from the individuals. For example: collective consciousness, collective memory, or collective wisdom. Among all these topics we will focus on collective decision making, that has influence in most of the collective intelligent behaviors. The field of study of decision making is really wide, and its evolution has been completely parallel to the aforementioned collective intelligence. Firstly, it was focused on the individual as the main decision-making entity, but later it became involved in studying social and institutional groups as basic decision-making entities. The first studies within the decision-making discipline were based on simple paradigms, such as pros and cons analysis, criteria prioritization, fulfillment, following orders, or even chance. However, in the same way that studying the community instead of the individual meant a paradigm shift within collective intelligence, collective decision-making means a new challenge for all the related disciplines. Besides, two new main topics come up when dealing with collective decision-making: centralized and decentralized decision-making systems. In this thesis project we focus in the second one, because it is the most interesting based on the opportunities to generate new knowledge and deal with open issues in this area, as well as these results can be put into practice in a wider set of real-life environments. Finally, within the decentralized collective decision-making systems discipline, there are several basic mechanisms that lead to different approaches to the specific problems of this field, for example: leadership, imitation, prescription, or fear. We will focus on trust and reputation. They are one of the most multidisciplinary concepts and with more potential for applying them in every kind of environments. Besides, they have historically shown that they can generate better performance than other decentralized decision-making mechanisms. Shortly, we say trust is the belief of one entity that the outcome of other entities’ actions is going to be in a specific way. It is a subjective concept because the trust of two different entities in another one does not have to be the same. Reputation is the collective idea (or social evaluation) that a group of entities within a system have about another entity based on a specific criterion. Thus, it is a collective concept in its origin. It is important to say that the behavior of most of the collective systems are based on these two simple definitions. In fact, a lot of articles and essays describe how any organization would not be viable if the ideas of trust and reputation did not exist. From now on, we call Trust an Reputation System (TRS) to any kind of system that uses these concepts. Even though TRSs are one of the most common everyday aspects in our lives, the existing knowledge about them could not be more dispersed. There are thousands of scientific works in every field of study related to trust and reputation: philosophy, psychology, sociology, economics, politics, information sciences, etc. But the main issue is that a comprehensive vision of trust and reputation for all these disciplines does not exist. Every discipline focuses its studies on a specific set of topics but none of them tries to take advantage of the knowledge generated in the other disciplines to improve its behavior or performance. Detailed topics in some fields are completely obviated in others, and even though the study of some topics within several disciplines produces complementary results, these results are not used outside the discipline where they were generated. This leads us to a very high knowledge dispersion and to a lack in the reuse of methodologies, policies and techniques among disciplines. Due to its great importance, this high dispersion of trust and reputation knowledge is one of the main problems this thesis contributes to solve. When we work with TRSs, all the aspects related to security are a constant since it is a vital aspect within the decision-making systems. Besides, TRS are often used to perform some responsibilities related to security. Finally, we cannot forget that the act of trusting is invariably attached to the act of delegating a specific responsibility and, when we deal with these concepts, the idea of risk is always present. This refers to the risk of generated expectations not being accomplished or being accomplished in a different way we anticipated. Thus, we can see that any system using trust to improve or enable its behavior, because of its own nature, is especially vulnerable if the premises it is based on are attacked. Related to this topic, we can see that the approaches of the different disciplines that study attacks of trust and reputation are very diverse. Some attempts of using approaches of other disciplines have been made within the information science area of knowledge, but these approaches are usually incomplete, not systematic and oriented to achieve specific requirements of specific applications. They never try to consolidate a common base of knowledge that could be reusable in other context. Based on all these ideas, this work makes the following direct contributions to the field of TRS: • The compilation of the most relevant existing knowledge related to trust and reputation management systems focusing on their advantages and disadvantages. • We define a generic architecture for TRS, identifying the main entities and processes involved. • We define a generic security framework for TRS. We identify the main security assets and propose a complete taxonomy of attacks for TRS. • We propose and validate a methodology to analyze, design, secure and deploy TRS in real-life environments. Additionally we identify the principal kind of applications we can implement with TRS and how TRS can provide a specific functionality. • We develop a software component to validate and optimize the behavior of a TRS in order to achieve a specific functionality or performance. In addition to the contributions made directly to the field of the TRS, we have made original contributions to different areas of knowledge thanks to the application of the analysis, design and security methodologies previously presented: • Detection of thermal anomalies in Data Centers. Thanks to the application of the TRS analysis and design methodologies, we successfully implemented a thermal anomaly detection system based on a TRS.We compare the detection performance of Self-Organized- Maps and Growing Neural Gas algorithms. We show how SOM provides better results for Computer Room Air Conditioning anomaly detection, yielding detection rates of 100%, in training data with malfunctioning sensors. We also show that GNG yields better detection and isolation rates for workload anomaly detection, reducing the false positive rate when compared to SOM. • Improving the performance of a harvesting system based on swarm computing and social odometry. Through the implementation of a TRS, we achieved to improve the ability of coordinating a distributed network of autonomous robots. The main contribution lies in the analysis and validation of the incremental improvements that can be achieved with proper use information that exist in the system and that are relevant for the TRS, and the implementation of the appropriated trust algorithms based on such information. • Improving Wireless Mesh Networks security against attacks against the integrity, confidentiality or availability of data and communications supported by these networks. Thanks to the implementation of a TRS we improved the detection time rate against these kind of attacks and we limited their potential impact over the system. • We improved the security of Wireless Sensor Networks against advanced attacks, such as insider attacks, unknown attacks, etc. Thanks to the TRS analysis and design methodologies previously described, we implemented countermeasures against such attacks in a complex environment. In our experiments we have demonstrated that our system is capable of detecting and confining various attacks that affect the core network protocols. We have also demonstrated that our approach is capable of rapid attack detection. Also, it has been proven that the inclusion of the proposed detection mechanisms significantly increases the effort the attacker has to introduce in order to compromise the network. Finally we can conclude that, to all intents and purposes, this thesis offers a useful and applicable knowledge in real-life environments that allows us to maximize the performance of any system based on a TRS. Thus, we deal with the main deficiency of this discipline: the lack of a common and complete base of knowledge and the lack of a methodology for the development of TRS that allow us to analyze, design, secure and deploy TRS in a systematic way.