A study on situational awareness security and privacy of wearable health monitoring devices

Situational Awareness provides a user centric approach to security and privacy. The human factor is often recognised as the weakest link in security, therefore situational perception and risk awareness play a leading role in the adoption and implementation of security mechanisms. In this study we assess the understanding of security and privacy of users in possession of wearable devices. The findings demonstrate privacy complacency, as the majority of users trust the application and the wearable device manufacturer. Moreover the survey findings demonstrate a lack of understanding of security and privacy by the sample population. Finally the theoretical implications of the findings are discussed.

The role of heart rate as a risk marker for predicting adverse outcomes

Cardiovascular disease is one of the leading causes of death around the world. Resting heart rate has been shown to be a strong and independent risk marker for adverse cardiovascular events and mortality, and yet its role as a predictor of risk is somewhat overlooked in clinical practice. With the aim of highlighting its prognostic value, the role of resting heart rate as a risk marker for death and other adverse outcomes was further examined in a number of different patient populations. A systematic review of studies that previously assessed the prognostic value of resting heart rate for mortality and other adverse cardiovascular outcomes was presented. New analyses of nine clinical trials were carried out. Both the original and extended Cox model that allows for analysis of time-dependent covariates were used to evaluate and compare the predictive value of baseline and time-updated heart rate measurements for adverse outcomes in the CAPRICORN, EUROPA, PROSPER, PERFORM, BEAUTIFUL and SHIFT populations. Pooled individual patient meta-analyses of the CAPRICORN, EPHESUS, OPTIMAAL and VALIANT trials, and the BEAUTIFUL and SHIFT trials, were also performed. The discrimination and calibration of the models applied were evaluated using Harrell’s C-statistic and likelihood ratio tests, respectively. Finally, following on from the systematic review, meta-analyses of the relation between baseline and time-updated heart rate, and the risk of death from any cause and from cardiovascular causes, were conducted. Both elevated baseline and time-updated resting heart rates were found to be associated with an increase in the risk of mortality and other adverse cardiovascular events in all of the populations analysed. In some cases, elevated time-updated heart rate was associated with risk of events where baseline heart rate was not. Time-updated heart rate also contributed additional information about the risk of certain events despite knowledge of baseline heart rate or previous heart rate measurements. The addition of resting heart rate to the models where resting heart rate was found to be associated with risk of outcome improved both discrimination and calibration, and in general, the models including time-updated heart rate along with baseline or the previous heart rate measurement had the highest and similar C-statistics, and thus the greatest discriminative ability. The meta-analyses demonstrated that a 5bpm higher baseline heart rate was associated with a 7.9% and an 8.0% increase in the risk of all-cause and cardiovascular death, respectively (both p less than 0.001). Additionally, a 5bpm higher time-updated heart rate (adjusted for baseline heart rate in eight of the ten studies included in the analyses) was associated with a 12.8% (p less than 0.001) and a 10.9% (p less than 0.001) increase in the risk of all-cause and cardiovascular death, respectively. These findings may motivate health care professionals to routinely assess resting heart rate in order to identify individuals at a higher risk of adverse events. The fact that the addition of time-updated resting heart rate improved the discrimination and calibration of models for certain outcomes, even if only modestly, strengthens the case that it be added to traditional risk models. The findings, however, are of particular importance, and have greater implications for the clinical management of patients with pre-existing disease. An elevated, or increasing heart rate over time could be used as a tool, potentially alongside other established risk scores, to help doctors identify patient deterioration or those at higher risk, who might benefit from more intensive monitoring or treatment re-evaluation. Further exploration of the role of continuous recording of resting heart rate, say, when patients are at home, would be informative. In addition, investigation into the cost-effectiveness and optimal frequency of resting heart rate measurement is required. One of the most vital areas for future research is the definition of an objective cut-off value for the definition of a high resting heart rate.

Desenlaces de la escala Omaha+ en los pacientes en cuidado intensivo en la fundación santa fe de Bogotá

Introducción La ventilación mecánica es fundamental en el manejo de la falla respiratoria aguda, actualmente no existe consenso sobre el momento exacto de extubación. Este estudio describe el comportamiento de la escala OMAHA+ en nuestra institución. Objetivo Principal Describir los desenlaces clínicos relacionados con la escala OMAHA+ durante la extubación de los pacientes de las unidades de cuidado intensivo del hospital universitario. Métodos Estudio descriptivo, retrospectivo, basado en el registro de la escala OMAHA+ de 68 pacientes durante el proceso de extubación en las Unidades de cuidado intensivo adulto de la Fundación Santa Fe de Bogotá durante Agosto de 2014 a Mayo de 2015. Resultados Se encontraron valores gasométricos cercanos a la normalidad, con una PaO2/FiO2 media de 261 (DS 60,6), SaO2 media de 96% (DS 2%), media de lactato sérico de 1.5 mmol/L (DS 1,2 mmol/L), con signos vitales normales. La causa más común de ingreso a UCI fue Neumonía, seguida por cirugía cardiaca y abdominal. Las medias de parámetros ventilatorios al momento de extubación fueron; PEEP de 6 (DS 0,8), volumen corriente de 8ml/Kg (DS 1,4 ml/Kg), índice de Tobín de 34 (DS 11,9), test de fuga positivo 94%, y sólo una extubación fallida. Conclusiones La escala OMAHA+ puede ser una herramienta útil, aplicable y fácilmente reproducible en los pacientes con soporte ventilatorio mecánico invasivo previo al proceso de extubación, con baja proporción de fallo. Estos resultados deben ser evaluados en estudios prospectivos.

The significant role of third-party logistics (3pl) operators as fosterers of organizational performance in colombian companies

La eliminación de barreras entre países es una consecuencia que llega con la globalización y con los acuerdos de TLC firmados en los últimos años. Esto implica un crecimiento significativo del comercio exterior, lo cual se ve reflejado en un aumento de la complejidad de la cadena de suministro de las empresas. Debido a lo anterior, se hace necesaria la búsqueda de alternativas para obtener altos niveles de productividad y competitividad dentro de las empresas en Colombia, ya que el entorno se ha vuelto cada vez más complejo, saturado de competencia no sólo nacional, sino también internacional. Para mantenerse en una posición competitiva favorable, las compañías deben enfocarse en las actividades que le agregan valor a su negocio, por lo cual una de las alternativas que se están adoptando hoy en día es la tercerización de funciones logísticas a empresas especializadas en el manejo de estos servicios. Tales empresas son los Proveedores de servicios logísticos (LSP), quienes actúan como agentes externos a la organización al gestionar, controlar y proporcionar actividades logísticas en nombre de un contratante. Las actividades realizadas pueden incluir todas o parte de las actividades logísticas, pero como mínimo la gestión y ejecución del transporte y almacenamiento deben estar incluidos (Berglund, 2000). El propósito del documento es analizar el papel de los Operadores Logísticos de Tercer nivel (3PL) como promotores del desempeño organizacional en las empresas colombianas, con el fin de informar a las MIPYMES acerca de los beneficios que se obtienen al trabajar con LSP como un medio para mejorar la posición competitiva del país.

Impact on hip fracture mortality after the establishment of an orthogeriatric care program in a colombian hospital

El objetivo del estudio es evaluar la mortalidad a un año en pacientes con fractura de cadera, mayores de 65 años tratados en un programa establecido de orto-geriatría. 298 se trataron de acuerdo al protocolo de orto-geriatría, se calculo la mortalidad a un año, se establecieron los predictores de mortalidad orto-geriátrico. La sobrevida anual se incremento de 80% a 89% (p = .039) durante los cuatro años de seguimiento del programa y disminuyo el riesgo de mortalidad anual postoperatorio (Hazard Ratio = 0.54, p = .049). La enfermedad cardiaca y la edad maor a 85 años fueron predictores positivos para mortalidad.

Perfil epidemiológico y análisis de la formulación antibiótica en pacientes con infección urinaria nosocomial en la Fundación Cardioinfantil en el año 2014

Introducción: La IVU es muy frecuenten en la (FCI - IC), Alrededor el 60% de los pacientes con diagnóstico de IVU nosocomial corresponden a gérmenes resistente, Desde el año 2010 el CLSI disminuyó los puntos de corte de sensibilidad en las enterobacteriaceae y removió la necesidad de tamizaje y confirmación de (BLEE), en el presente trabajo se pretende determinar el perfil epidemiológico de la formulación antibiótica en pacientes con IVU nosocomial. Diseño: Se realizó un estudio observacional analítico de corte transversal. Métodos: Se realizó un análisis univariado, bivariado y multivariado. El análisis bivariado y multivariado se realizó para determinar la medida de asociación teniendo en cuenta la formulación de Carbapenemico la variable dependiente, evaluándose mediante chi cuadrado. Resultados: Se revisaron 131 urocultivos, se incluyeron 116. Los aislamientos microbiológicos más frecuentemente encontrados fueron E. Coli y K. Pneumoniae, el 43.4% de los aislamientos, presentaron expresión de BLEE, 90% de los aislamientos fueron sensibles a Cefepime. La mayoría de los modelos obtenidos mostraron una fuerte asociación entre el reporte de BLEE en antibiograma con la formulación de carbapenémicos como terapia final OR 33,12 IC 95% (2,90 – 337,4). Conclusión: La epidemiologia de la IVU nosocomial en la FCI-IC no difiere de las referencias internacionales, no hay adherencia a las guías de manejo intrahospitalario y el reporte de la palabra BLEE en el antibiograma predice la formulación de antibiótico carbapenémico por el médico que lee el urocultivo

Asociación de las violencias física, sexual y comunitaria con el embarazo en adolescentes: análisis multinivel

Objetivos Determinar si existe asociación entre la exposición a violencia, experimentada a nivel individual o municipal, y el embarazo adolescente en mujeres Colombianas entre 13 y 19 años de edad que contestaron la Encuesta de Demografía y Salud en el año 2010. Métodos Estudio de corte transversal, nacional y multinivel. Se tomaron datos de dos niveles jerárquicos: Nivel- 1: Datos individuales de una muestra representativa de 13.313 mujeres entre 13 y 19 años de edad provenientes de La Encuesta Nacional de Demografía y Salud del año 2010 y Nivel- 2: Datos municipales de 258 municipios provenientes de las estadísticas vitales del DANE. Resultados La prevalencia del embarazo adolescente fue del 16.8% IC 95% [16.2-17.4]. El análisis mostró que la asociación entre embarazo adolescente y violencia tanto individual, representada como violencia sexual [OR= 6.99 IC99% 4.80-10.10] y violencia física [OR= 1.74 IC99% 1.47-2.05] así como la violencia municipal medida con tasas de homicidios altas [OR= 1.99 IC99% 1.29-3.07] y muy altas [OR= 2.10 IC99% 1.21-3.61] se mantuvo estadísticamente significativa después de ajustar por las variables: Edad [OR= 1.81 IC99% 1.71-1.91], ocupación [OR= 1.62 IC99% 1.37-1.93], educación primaria o sin educación [OR= 2.20 IC99% 1.47-3.30], educación secundaria [OR= 1.70 IC99% 1.24-2.32], asistir al colegio [OR= 0.18 IC99% 0.15-0.21], conocimiento en la fisiología reproductiva [OR= 1.28 IC99% 1.06-1.54], el índice de riqueza Q1, Q2, Q3 [OR= 2.18 IC99% 1.42-3.34], [OR= 2.00 IC99% 1.39-2.28], [OR= 1.82 IC99% 1.92-2.25] y alto porcentaje de Necesidades básicas insatisfechas a nivel municipal [OR= 2.34 IC99% 1.55-3.52]. Conclusiones Este estudio mostró una relación significativamente estadística entre la violencia sexual y física con el inicio de relaciones sexuales y embarazo adolescente después de controlar por factores sociodemográficos y conocimientos en reproducción sexual en mujeres colombianas de 13 a 19 años en el año 2010. Esta asociación debe continuar siendo estudiada para lograr optimizar las estrategias de prevención y disminuir la tasa actual de embarazos adolescentes en el país y sus consecuencias.

Fibrinolysis Versus Primary Pci In Stemi Patients Enrolled In The International Survey Of Acute Coronary Syndromes In Transitional Countries

Primary angioplasty has been shown to be more effective than fibrinolysis in terms of mortality and adverse outcomes. More recent data, however, suggests that timely reperfusion with fibrinolysis is comparable to primary angioplasty. The current study gathered data from the International Survey of Acute Coronary Syndromes in Transitional Countries registry. Among 7406 ST-elevation myocardial infarction patients presenting within 12 hours from symptom onset, 6315 underwent primary percutaneous coronary intervention and 1091 were treated with fibrinolysis. The primary outcome was 30-day mortality, while the secondary outcome was a composite of 30-day incidence of death, severe left ventricular dysfunction, stroke or reinfarction. Patients who underwent primary angioplasty tended to have a greater cardiovascular risk profile and were slightly older. On the other hand, patients treated with fibrinolysis received less anti-platelet medications yet were more often prescribed beta blockers in the acute phase. Among those who received fibrinolysis, 43% underwent coronary angiography while 32.3% were treated with a subsequent angioplasty. Total ischemic time was lower in patients undergoing fibrinolysis (185 minutes) than in those treated with primary angioplasty (258 minutes). Rates of primary and secondary combined endpoints were higher in patients receiving fibrinolysis compared to those receiving primary angioplasty (7.8% vs. 4.1%; p<0.0001; OR 1.97, 95% CI, 1.38-2.81; and 14.8% vs. 10.1%, p<0.0001; OR 1.43, 95% CI, 1.12-1.81). When considering only patients receiving reperfusion within 3 hours, regardless of reperfusion strategy, differences in mortality (6.3% vs. 4%, p=0.094, for fibrinolysis or primary angioplasty, respectively; OR 0.87, 95% CI, 0.35-2.16) and in the combined secondary endpoint were no longer observed (12.9% vs 10.8%, p=0.33; OR 0.98, 95% CI, 0.58-1.64), and female sex was no longer a significant predictor of adverse outcomes. When performed 3 hours from symptom onset, fibrinolysis is safe and feasible, in terms of mortality and adverse outcomes, compared to primary angioplasty.

A first survey on the status of the Posidonia oceanica meadow in Calpe Bay (Alicante, Spain).

Posidonia oceanica, endemic seagrass of the Mediterranean Sea, forms extensive meadows. It is included among the Mediterranean protected habitats by the Habitat Directive (92/43/EEC). P. oceanica meadows are exposed to anthropogenic impacts that are more evident in areas close to cities, ports or areas with a large coastal tourism development. Mean exponential decline rate of 5 % yr-1 is estimated for the Spanish meadows. If this trend is maintained, most of the meadows are predicted to halve in shoot density over the next 20 years. The meadows regression can give way to a new regime, which supposes the loss of the multiple services that the meadows provided. It is necessary to recognize situations of stress in time, before irreversible damages and changes towards alternative regimes are evident. This study has been carried out in Calpe Bay, Alicante (Spain), during May and June 2017, with the aim of assessing, for the first time, the status of the P. oceanica meadows providing a baseline data for the future monitoring scheme. The features and status of the seagrass beds have been assessed by physical, physiographical, structural and functional descriptors. The results showed that the health status classification of P. oceanica meadows in Calpe Bay vary between “equilibrium” and “disturbed”. The “disturbed” conditions were observed in a shaded area where it is probably due to the low solar radiance. In a lower limit in a shallow meadow, where it could be due to the combined effect of substrate structure and hydrodynamic regime. Finally in a touristic area where patchy impacts could be attributed to direct human disturbance (e.g. anchoring). Overall the status of P. oceanica meadows in Calpe bay is not worrying. However, it is important to develop monitoring plans to assess the dynamics of the seagrass detecting any early decline symptom in order to act, as soon as possible because, when a regression of a meadow is produced, it could not be recovered at human scales.

Real-time PMU monitoring of an IEEE 5-Bus Network implemented on OPAL system

This thesis studies the state-of-the-art of phasor measurement units (PMUs) as well as their metrological requirements stated in the IEEE C37.118.1 and C37.118.2 Standards for guaranteeing correct measurement performances. Communication systems among PMUs and their possible applicability in the field of power quality (PQ) assessment are also investigated. This preliminary study is followed by an analysis of the working principle of real-time (RT) simulators and the importance of hardware-in-the-loop (HIL) implementation, examining the possible case studies specific for PMUs, including compliance tests which are one of the most important parts. The core of the thesis is focused on the implementation of a PMU model in the IEEE 5-bus network in Simulink and in the validation of the results using OPAL RT-4510 as a real-time simulator. An initial check allows one to get an idea about the goodness of the results in Simulink, comparing the PMU data with respect to the load-flow steady-state information. In this part, accuracy indices are also calculated for both voltage and current synchrophasors. The following part consists in the implementation of the same code in OPAL-RT 4510 simulator, after which an initial analysis is carried out in a qualitative way in order to get a sense of the goodness of the outcomes. Finally, the confirmation of the results is based on an examination of the attained voltage and current synchrophasors and accuracy indices coming from Simulink models and from OPAL system, using a Matlab script. This work also proposes suggestions for an upcoming operation of PMUs in a more complex system as the Digital Twin (DT) in order to improve the performances of the already-existing protection devices of the distribution system operator (DSO) for a future enhancement of power systems reliability.

Evaluation of deambulation in a protected environment and in the public green in limb amputated subjects treated through a new osteointegration method

The limb amputation is one of the oldest surgical procedures performed and it still represents an event that drastically changes the life of an individual. Despite the technological progress, the difficulties related to the realization and daily use of the socket remain very common. Among the different technologies adopted in the prosthetic field, this project focused on the osseointegration technique. This technique consists in implanting a stem within the medullary canal of the amputated skeletal segment that extends outside the amputation stump with a prosthesis, later connected to the metal extension. The objective of this PhD project is to treat and to evaluate selected patients with osseointegrated prosthetic implants for the treatment of lower limb amputations. Patients are recruited at the Rizzoli Orthopaedic Institute and at the Prosthesis - INAIL center of Vigorso (Budrio) during outpatient visits, while the surgical procedure is performed by the same expert surgeon in the II Orthopaedic and Traumatology Clinic of the Rizzoli Orthopaedic Institute. The project is still ongoing, to date three patients had completed both procedures, but due to various personal problems, just one of them is included in the analysis. This patient increased his percentage of prosthesis use and the level of mobility with an overall improvement of quality of live after the procedure. The osseointegration technique represents a promising alternative method of treatment for amputees who are not satisfied with their socket prosthesis. In the coming years it will continue the collection of clinical, radiographic and kinematic data of subjects undergoing this procedure in order to perform a long-term monitoring of both clinical outcomes and quality of life.

Analysis of urban infrastructure for sustainable mobility through instrumented bicycles for students

In Europe almost 80% of the continent's population lives in cities. It is estimated that by 2030 most regions in Europe which contain major cities will have even more inhabitants on 35–60% more than now. This process generates a consequent elevate human pressure on the natural environment, especially around large urban agglomerations. Cities could be seen as an ecosystem, represented by the dominance of humans that re-distribute organisms and fluxes and represent the result of co-evolving human and natural systems, emerging from the interactions between humans, natural and infrastructures. Roads have a relevant role in building links between urban components, creating the basis on which it is founded the urban ecosystem itself. This thesis is focused on the research for a comprehensive model, framed in European urban health & wellbeing programme, aimed to evaluate the determinants of health in urban populations. Through bicycles, GPS and sensor kits, specially developed and produced by University of Bologna for this purpose, it has been possible to conduct on Bologna different direct observations that oriented the novelty of the research: the categorization of university students cyclists, connection among environmental data awareness and level of cycling, and an early identification of urban attributes able to impact on road air quality and level of cycling. The categorization of university students’ cyclist has been defined through GPS analysis and focused survey, that both permit to identify behavioural and technical variables and attitudes towards urban cycling. The statistic relationship between level of cycling, seen as number of bicycles passages per lane and pollutants level, has been investigated through an inverse regression model, defined and tested through SPSS software on the basis of the data harvest. The research project that represents a sort of dynamic mobility laboratory on two wheels, that permits to harvest and study detected parameters.

R.P.C.M. Apulia (Reconstructing Prehistoric Communities’ Mobility in Apulia)

The research originates in the necessity to bring a new systematic archaeological perspective to the prehistoric background of northern Apulia. Therefore, the aim of the R.P.C.M. Apulia project is to shed new light on a specific chronological arch, from the Neolithic to Early Bronze Age, of the northern part of the Apulia, because the related studies resulted updated to the 70-80’s with some sporadic exception. Moreover, addressing the investigation to the relationship between the communities and the landscape, so how they could exploit the lands and how they could move into this area keeping in touch. To reconstruct the Prehistorical dynamics, it has been necessary first of all to create a database containing all the information about the sites thus to validate them and classifying them according to a model specifically built. The storing operation has been conducted with the software ArcGIS v.10.1 and the sites have been georeferenced on the map as points. It provided the basis on which developing the analysis concerning the mobility (Least Cost Path) and landscape perception (Fuzzy Viewshed Analysis). The first one has been considered to evaluate the mobility into the study area. Therefore, to generate sample paths on the base of the time in reaching a specific point and the terrain trend. The gained information has been collected to hypothesize how they could keep in touch across the chronological changes for purposes related to trading/idea/people exchanges. The visibility analysis has been led to grasp how the groups perceived the landscape through the sight. This datum covered an important role, especially from the Copper Age, concerning the domain and control of the trading ways. The data coming from the mentioned analysis have been used to read into the settlement choices according to the development of the new socio-economic relationships and plan survey activity.

Physical activity as a tool to improve the quality of life for individuals with hip or knee osteoarthritis

Total hip and knee replacements (THR/TKR) are considered the gold standard surgical treatments for end-stage osteoarthritis (OA), effectively alleviating pain, enhancing joint mobility and quality of life (QoL). Maintaining an active lifestyle and regular physical activity (PA) is crucial for these patients, as it can increase bone density and stability of joint prosthesis. This thesis aims to: (1) systematically review recommendations from healthcare professionals; (2) explore interventions promoting an active lifestyle post-THR and TKR; (3) investigate the primary causes of stiffness post-TKR; (4) design an exercise protocol to enhance QoL post-THR and TKR; (5) evaluate orthopedic surgeons' attitudes toward PA for patients post-THR/TKR; and (6) assess changes in QoL after a specifically designed PA intervention. The initial review revealed consensus on permissible sports activities post-surgery, but few studies addressed interventions targeting PA behaviors. Subsequently, findings highlighted key factors contributing to post-TKR stiffness, including mispositioned components, psychological distress, and obesity. Building on these insights, a PA intervention was implemented, followed by a survey investigating orthopedic surgeons' attitudes towards PA, which demonstrated a general positive attitude. Lastly, a pilot randomized controlled trial demonstrated significant enhancements in QoL, physical function, and clinical outcomes following a three-month adapted PA intervention. Future research should focus on raising awareness among individuals and healthcare professionals, fostering engagement in PA programs, and promoting active lifestyles. PA represents a valuable strategy for mitigating the burden of chronic diseases on society.

Urban air mobility: modelling the future transport system

The advances in the aviation field, particularly the development of electric flying vehicles, as UAV and eVTOL, paved the way for setting Urban Air Mobility (UAM) services. UAM would provide services for passengers, goods and emergencies and could offer faster trips than ground ones. It is expected that early UAM operations will be performed at Very Low-Level airspace as 0-500 m Above Ground Level. The purpose of this research is to both explore the main features of UAM and test an aerial network model, which could be integrated in a multimodal transport system where ground and aerial mobility services are provided. Analyses on UAM transport system involved two sub-systems: the transport demand sub-system, i.e., the mobility requirements, and the transport supply sub-system, i.e., the service and facilities enabling mobility. At first, the UAM demand levels and features for an Airport Shuttle service have been explored through a suitable survey, by combining Revealed and Stated Preference methodologies, and by calibrating some discrete mode choice models. Then, the focus has been on the transport supply model for UAM services, by focusing on both the ground access points (vertiports) and the aerial network model. A suitable three-dimensional urban aerial network (3D-UAN) model that could support fast aerial connections between O/D pairs has been proposed. Some tests have been implemented to verify the feasibility of the proposed model. Some flying vehicles supporting an Airport Shuttle service have been simulated on the aerial network, which has been specified in terms of both topological features and link transport costs. The preliminary results have showed that the proposed 3D-UAN model could be suitable for supporting UAM services. As for transport engineering, the UAM system framework proposed in this thesis paves the way for further research on air-ground multimodality in urban areas.