Prediction of 1-year mortality in patients with acute coronary syndromes undergoing percutaneous coronary intervention: validation of the logistic clinical SYNTAX (Synergy Between Percutaneous Coronary Interventions With Taxus and Cardiac Surgery) score

OBJECTIVES This study sought to validate the Logistic Clinical SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score in patients with non-ST-segment elevation acute coronary syndromes (ACS), in order to further legitimize its clinical application. BACKGROUND The Logistic Clinical SYNTAX score allows for an individualized prediction of 1-year mortality in patients undergoing contemporary percutaneous coronary intervention. It is composed of a "Core" Model (anatomical SYNTAX score, age, creatinine clearance, and left ventricular ejection fraction), and "Extended" Model (composed of an additional 6 clinical variables), and has previously been cross validated in 7 contemporary stent trials (>6,000 patients). METHODS One-year all-cause death was analyzed in 2,627 patients undergoing percutaneous coronary intervention from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial. Mortality predictions from the Core and Extended Models were studied with respect to discrimination, that is, separation of those with and without 1-year all-cause death (assessed by the concordance [C] statistic), and calibration, that is, agreement between observed and predicted outcomes (assessed with validation plots). Decision curve analyses, which weight the harms (false positives) against benefits (true positives) of using a risk score to make mortality predictions, were undertaken to assess clinical usefulness. RESULTS In the ACUITY trial, the median SYNTAX score was 9.0 (interquartile range 5.0 to 16.0); approximately 40% of patients had 3-vessel disease, 29% diabetes, and 85% underwent drug-eluting stent implantation. Validation plots confirmed agreement between observed and predicted mortality. The Core and Extended Models demonstrated substantial improvements in the discriminative ability for 1-year all-cause death compared with the anatomical SYNTAX score in isolation (C-statistics: SYNTAX score: 0.64, 95% confidence interval [CI]: 0.56 to 0.71; Core Model: 0.74, 95% CI: 0.66 to 0.79; Extended Model: 0.77, 95% CI: 0.70 to 0.83). Decision curve analyses confirmed the increasing ability to correctly identify patients who would die at 1 year with the Extended Model versus the Core Model versus the anatomical SYNTAX score, over a wide range of thresholds for mortality risk predictions. CONCLUSIONS Compared to the anatomical SYNTAX score alone, the Core and Extended Models of the Logistic Clinical SYNTAX score more accurately predicted individual 1-year mortality in patients presenting with non-ST-segment elevation acute coronary syndromes undergoing percutaneous coronary intervention. These findings support the clinical application of the Logistic Clinical SYNTAX score.

Impacts of out-migration on land management in mountain areas

INTRODUCTION Out-migration from mountain areas is leaving behind half families and elderly to deal with managing the land alongside daily life challenges. A potential reduction of labour force as well as expertise on cropping practices, maintenance of terraces and irrigation canals, slope stabilization, grazing, forest and other land management practices are further challenged by changing climate conditions and increased environmental threats. An understanding of the resilience of managed land resources in order to enhance adaptation to environmental and socio-economic variability, and evidence of the impact of Sustainable Land Management (SLM) on the mitigation of environmental threats have so far not sufficiently been tackled. The study presented here aims to find out how land management in mountains is being affected by migration in the context of natural hazards and climate change in two study sites, namely Quillacollo District of Bolivia and Panchase area of Western Nepal, and which measures are needed to increase resilience of livelihoods and land management practices. The presentation includes draft results from first field work periods in both sites. A context of high vulnerability According to UNISDR, vulnerability is defined as “the characteristics and circumstances of a community, system or asset that make it susceptible to the damaging effects of a hazard”.Hazards are another threat affecting people’s livelihood in mountainous area. They can be either natural or human induced. Landslides, debris flow and flood are affecting peopleGood land management can significantly reduce occurrence of hazards. In the opposite bad land management or land abandonment can lead to negative consequences on the land, and thus again increase vulnerability of people’s livelihoods. METHODS The study integrates bio-physical and socio-economic data through a case study as well as a mapping approach. From the social sciences, well-tested participatory qualitative methodologies, typically used in Vulnerability and Capacity Analyses, such as semi-structured interviews with so-called ‘key informants’, transect walks, participatory risk and social resource mapping are applied. The bio-physical analysis of the current environmental conditions determining hazards and structural vulnerability are obtained from remote sensing analysis, field work studies, and GIS analysis The assessment of the consequences of migration in the area of origin is linked with a mapping and appraisal of land management practices (www.wocat.net, Schwilch et al., 2011). The WOCAT mapping tool (WOCAT/LADA/DESIRE 2008) allows capturing the major land management practices / technologies, their spread, effectiveness and impact within a selected area. Data drawn from a variety of sources are compiled and harmonised by a team of experts, consisting of land degradation and conservation specialists working in consultation with land users from various backgrounds. The specialists’ and land users’ knowledge is combined with existing datasets and documents (maps, GIS layers, high-resolution satellite images, etc.) in workshops that are designed to build consensus regarding the variables used to assess land degradation and SLM. This process is also referred to as participatory expert assessment or consensus mapping. The WOCAT mapping and SLM documentation methodologies are used together with participatory mapping and other socio-economic data collection (interviews, questionnaires, focus group discussions, expert consultation) to combine information about migration types and land management issues. GIS and other spatial visualization tools (e.g. Google maps) will help to represent and understand these links. FIRST RESULTS Nepal In Nepal, migration is a common strategy to improve the livelihoods. Migrants are mostly men and they migrate to other Asian countries, first to India and then to the Gulf countries. Only a few women are migrating abroad. Women migrate essentially to main Nepali cities when they can afford it. Remittances are used primarily for food and education; however they are hardly used for agricultural purposes. Besides traditional agriculture being maintained, only few new practices are emerging, such as vegetable farming or agroforestry. The land abandonment is a growing consequence of outmigration, resulting in the spreading of invasive species. However, most impacts of migration on land management are not yet clear. Moreover, education is a major concern for the respondents; they want their children having a better education and get better opportunities. Linked to this, unemployment is another major concern of the respondents, which in turn is “solved” through outmigration. Bolivia Migration is a common livelihood strategy in Bolivia. In the area of study, whole families are migrating downward to the cities of the valleys or to other departments of Bolivia, especially to Chapare (tropics) for the coca production and to Santa Cruz. Some young people are migrating abroad, mostly to Argentina. There are few remittances and if those are sent to the families in the mountain areas, then they are mainly used for agriculture purpose. The impacts of migration on land management practices are not clear although there are some important aspects to be underlined. The people who move downward are still using their land and coming back during part of the week to work on it. As a consequence of this multi-residency, there is a tendency to reduce land management work or to change the way the land is used. As in Nepal, education is a very important issue in this area. There is no secondary school, and only one community has a primary school. After the 6th grade students have therefore to go down into the valley towns to study. The lack of basic education is pushing more and more people to move down and to leave the mountains. CONCLUSIONS This study is on-going, more data have to be collected to clearly assess the impacts of out-migration on land management in mountain areas. The first results of the study allow us to present a few interesting findings. The two case studies are very different, however in both areas, young people are not staying anymore in the mountains and leave behind half families and elderly to manage the land. Additionally in both cases education is a major reason for moving out, even though the causes are not always the same. More specifically, in the case of Nepal, the use of remittances underlines the fact that investment in agriculture is not the first choice of a family. In the case of Bolivia, some interesting findings showed that people continue to work on their lands even if they move downward. The further steps of the study will help to explore these interesting issues in more detail. REFERENCES Schwilch G., Bestelmeyer B., Bunning S., Critchley W., Herrick J., Kellner K., Liniger H.P., Nachtergaele F., Ritsema C.J., Schuster B., Tabo R., van Lynden G., Winslow M. 2011. Experiences in Monitoring and Assessment of Sustainable Land Management. Land Degradation & Development 22 (2), 214-225. Doi 10.1002/ldr.1040 WOCAT/LADA/DESIRE 2008. A Questionnaire for Mapping Land Degradation and Sustainable Land Management. Liniger H.P., van Lynden G., Nachtergaele F., Schwilch G. (eds), Centre for Development and Environment, Institute of Geography, University of Berne, Berne

The significant effect of endometriosis on physical, mental and social wellbeing: results from an international cross-sectional survey.

STUDY QUESTION To what extent do the management of endometriosis and the symptoms that remain after treatment affect the quality of life in women with the disease? SUMMARY ANSWER Many women with endometriosis had impaired quality of life and continued to suffer from endometriosis-associated symptoms even though their endometriosis has been managed in tertiary care centres. WHAT IS KNOWN ALREADY The existing literature indicates that quality of life and work productivity is reduced in women with endometriosis. However, most studies have small sample sizes, are treatment related or examine newly diagnosed patients only. STUDY DESIGN, SIZE, DURATION A cross-sectional questionnaire-based survey among 931 women with endometriosis treated in 12 tertiary care centres in 10 countries. PARTICIPANTS/MATERIALS, SETTING, METHODS Women diagnosed with endometriosis who had at least one contact related to endometriosis-associated symptoms during 2008 with a participating centre were enrolled into the study. The study investigated the effect of endometriosis on education, work and social wellbeing, endometriosis-associated symptoms and health-related quality of life, by using questions obtained from the World Endometriosis Research Foundation (WERF) GSWH instrument (designed and validated for the WERF Global Study on Women's Health) and the Short Form 36 version 2 (SF-36v2). MAIN RESULTS AND THE ROLE OF CHANCE Of 3216 women invited to participate in the study, 1450 (45%) provided informed consent and out of these, 931 (931/3216 = 29%) returned the questionnaires. Endometriosis had affected work in 51% of the women and affected relationships in 50% of the women at some time during their life. Dysmenorrhoea was reported by 59%, dyspareunia by 56% and chronic pelvic pain by 60% of women. Quality of life was decreased in all eight dimensions of the SF-36v2 compared with norm-based scores from a general US population (all P < 0.01). Multivariate regression analysis showed that number of co-morbidities, chronic pain and dyspareunia had an independent negative effect on both the physical and mental component of the SF-36v2. LIMITATIONS, REASONS FOR CAUTION The fact that women were enrolled in tertiary care centres could lead to a possible over-representation of women with moderate-to-severe endometriosis, because the participating centres typically treat more complex and referred cases of endometriosis. The response rate was relatively low. Since there was no Institute Review Board approval to do a non-responder investigation on basic characteristics, some uncertainty remains regarding the representativeness of the investigated population. WIDER IMPLICATIONS OF THE FINDINGS This international multicentre survey represents a large group of women with endometriosis, in all phases of the disease, which increases the generalizability of the data. Women still suffer from frequent symptoms, despite tertiary care management, in particular chronic pain and dyspareunia. As a result their quality of life is significantly decreased. A patient-centred approach with extensive collaboration across disciplines, such as pain specialists, psychologists, sexologists and social workers, may be a valuable strategy to improve the long-term care of women with endometriosis. STUDY FUNDING/COMPETING INTEREST(S) The WERF EndoCost study is funded by the World Endometriosis Research Foundation (WERF) through grants received from Bayer Schering Pharma AG, Takeda Italia Farmaceutici SpA, Pfizer Ltd and the European Society of Human Reproduction and Embryology. The sponsors did not have a role in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript. L.H. is the chief executive and T.D. was a board member of WERF at the time of funding. T.D. holds the Merck-Serono Chair in Reproductive Medicine and Surgery, and the Ferring Chair in Reproductive Medicine at the Katholieke Universiteit Leuven in Belgium and has served as consultant/research collaborator for Merck-Serono, Schering-Plough, Astellas and Arresto.

Validation of the IMPACT-III quality of life questionnaire in Swiss children with inflammatory bowel disease

BACKGROUND AND AIMS Inflammatory bowel disease (IBD) frequently manifests during childhood and adolescence. For providing and understanding a comprehensive picture of a patients' health status, health-related quality of life (HRQoL) instruments are an essential complement to clinical symptoms and functional limitations. Currently, the IMPACT-III questionnaire is one of the most frequently used disease-specific HRQoL instrument among patients with IBD. However, there is a lack of studies examining the validation and reliability of this instrument. METHODS 146 paediatric IBD patients from the multicenter Swiss IBD paediatric cohort study database were included in the study. Medical and laboratory data were extracted from the hospital records. HRQoL data were assessed by means of standardized questionnaires filled out by the patients in a face-to-face interview. RESULTS The original six IMPACT-III domain scales could not be replicated in the current sample. A principal component analysis with the extraction of four factor scores revealed the most robust solution. The four factors indicated good internal reliability (Cronbach's alpha=.64-.86), good concurrent validity measured by correlations with the generic KIDSCREEN-27 scales and excellent discriminant validity for the dimension of physical functioning measured by HRQoL differences for active and inactive severity groups (p<.001, d=1.04). CONCLUSIONS This study with Swiss children with IBD indicates good validity and reliability for the IMPACT-III questionnaire. However, our findings suggest a slightly different factor structure than originally proposed. The IMPACT-III questionnaire can be recommended for its use in clinical practice. The factor structure should be further examined in other samples.

Development and validation of a novel pedometer algorithm to quantify extended characteristics of the locomotor behavior of dairy cows

Behavior is one of the most important indicators for assessing cattle health and well-being. The objective of this study was to develop and validate a novel algorithm to monitor locomotor behavior of loose-housed dairy cows based on the output of the RumiWatch pedometer (ITIN+HOCH GmbH, Fütterungstechnik, Liestal, Switzerland). Data of locomotion were acquired by simultaneous pedometer measurements at a sampling rate of 10 Hz and video recordings for manual observation later. The study consisted of 3 independent experiments. Experiment 1 was carried out to develop and validate the algorithm for lying behavior, experiment 2 for walking and standing behavior, and experiment 3 for stride duration and stride length. The final version was validated, using the raw data, collected from cows not included in the development of the algorithm. Spearman correlation coefficients were calculated between accelerometer variables and respective data derived from the video recordings (gold standard). Dichotomous data were expressed as the proportion of correctly detected events, and the overall difference for continuous data was expressed as the relative measurement error. The proportions for correctly detected events or bouts were 1 for stand ups, lie downs, standing bouts, and lying bouts and 0.99 for walking bouts. The relative measurement error and Spearman correlation coefficient for lying time were 0.09% and 1; for standing time, 4.7% and 0.96; for walking time, 17.12% and 0.96; for number of strides, 6.23% and 0.98; for stride duration, 6.65% and 0.75; and for stride length, 11.92% and 0.81, respectively. The strong to very high correlations of the variables between visual observation and converted pedometer data indicate that the novel RumiWatch algorithm may markedly improve automated livestock management systems for efficient health monitoring of dairy cows.

External validation of the Hospital-patient One-year Mortality Risk (HOMR) model for predicting death within 1 year after hospital admission

BACKGROUND Predicting long-term survival after admission to hospital is helpful for clinical, administrative and research purposes. The Hospital-patient One-year Mortality Risk (HOMR) model was derived and internally validated to predict the risk of death within 1 year after admission. We conducted an external validation of the model in a large multicentre study. METHODS We used administrative data for all nonpsychiatric admissions of adult patients to hospitals in the provinces of Ontario (2003-2010) and Alberta (2011-2012), and to the Brigham and Women's Hospital in Boston (2010-2012) to calculate each patient's HOMR score at admission. The HOMR score is based on a set of parameters that captures patient demographics, health burden and severity of acute illness. We determined patient status (alive or dead) 1 year after admission using population-based registries. RESULTS The 3 validation cohorts (n = 2,862,996 in Ontario, 210 595 in Alberta and 66,683 in Boston) were distinct from each other and from the derivation cohort. The overall risk of death within 1 year after admission was 8.7% (95% confidence interval [CI] 8.7% to 8.8%). The HOMR score was strongly and significantly associated with risk of death in all populations and was highly discriminative, with a C statistic ranging from 0.89 (95% CI 0.87 to 0.91) to 0.92 (95% CI 0.91 to 0.92). Observed and expected outcome risks were similar (median absolute difference in percent dying in 1 yr 0.3%, interquartile range 0.05%-2.5%). INTERPRETATION The HOMR score, calculated using routinely collected administrative data, accurately predicted the risk of death among adult patients within 1 year after admission to hospital for nonpsychiatric indications. Similar performance was seen when the score was used in geographically and temporally diverse populations. The HOMR model can be used for risk adjustment in analyses of health administrative data to predict long-term survival among hospital patients.

The Spanish translation, cultural adaptation and validation of the Powe Fatalism Inventory

Background/significance. The scarcity of reliable and valid Spanish language instruments for health related research has hindered research with the Hispanic population. Research suggests that fatalistic attitudes are related to poor cancer screening behaviors and may be one reason for low participation of Mexican-Americans in cancer screening. This problem is of major concern because Mexican-Americans constitute the largest Hispanic subgroup in the U.S.^ Purpose. The purposes of this study were: (1) To translate the Powe Fatalism Inventory, (PFI) into Spanish, and culturally adapt the instrument to the Mexican-American culture as found along the U.S.-Mexico border and (2) To test the equivalence between the Spanish translated, culturally adapted version of the PFI and the English version of the PFI to include clarity, content validity, reading level and reliability.^ Design. Descriptive, cross-sectional.^ Methods. The Spanish language translation used a translation model which incorporates a cultural adaptation process. The SPFI was administered to 175 bilingual participants residing in a midsize, U.S-Mexico border city. Data analysis included estimation of Cronbach's alpha, factor analysis, paired samples t-test comparison and multiple regression analysis using SPSS software, as well as measurement of content validity and reading level of the SPFI. ^ Findings. A reliability estimate using Cronbach's alpha coefficient was 0.81 for the SPFI compared to 0.80 for the PFI in this study. Factor Analysis extracted four factors which explained 59% of the variance. Paired t-test comparison revealed no statistically significant differences between the SPFI and PFI total or individual item scores. Content Validity Index was determined to be 1.0. Reading Level was assessed to be less than a 6th grade reading level. The correlation coefficient between the SPFI and PFI was 0.95.^ Conclusions. This study provided strong psychometric evidence that the Spanish translated, culturally adapted SPFI is an equivalent tool to the English version of the PFI in measuring cancer fatalism. This indicates that the two forms of the instrument can be used interchangeably in a single study to accommodate reading and speaking abilities of respondents. ^

DISPRO datasets for validation of coastal hydrodynamic models

Appropriate field data are required to check the reliability of hydrodynamic models simulating the dispersion of soluble substances in the marine environment. This study deals with the collection of physical measurements and soluble tracer data intended specifically for this kind of validation. The intensity of currents as well as the complexity of topography and tides around the Cap de La Hague in the center of the English Channel makes it one of the most difficult areas to represent in terms of hydrodynamics and dispersion. Controlled releases of tritium - in the form of HTO - are carried out in this area by the AREVA-NC plant, providing an excellent soluble tracer. A total of 14 493 measurements were acquired to track dispersion in the hours and days following a release. These data, supplementing previously gathered data and physical measurements (bathymetry, water-surface levels, Eulerian and Lagrangian current studies) allow us to test dispersion models from the hour following release to periods of several years which are not accessible with dye experiments. The dispersion characteristics are described and methods are proposed for comparing models against measurements. An application is proposed for a 2 dimensions high-resolution numerical model. It shows how an extensive dataset can be used to build, calibrate and validate several aspects of the model in a highly dynamic and macrotidal area: tidal cycle timing, tidal amplitude, fixed-point current data, hodographs. This study presents results concerning the model's ability to reproduce residual Lagrangian currents, along with a comparison between simulation and high-frequency measurements of tracer dispersion. Physical and tracer data are available from the SISMER database of IFREMER (www.ifremer.fr/sismer/catal). This tool for validation of models in macro-tidal seas is intended to be an open and evolving resource, which could provide a benchmark for dispersion model validation.

Medication double-checking procedures in clinical practice: a cross-sectional survey of oncology nurses' experiences.

BACKGROUND Double-checking is widely recommended as an essential method to prevent medication errors. However, prior research has shown that the concept of double-checking is not clearly defined, and that little is known about actual practice in oncology, for example, what kind of checking procedures are applied. OBJECTIVE To study the practice of different double-checking procedures in chemotherapy administration and to explore nurses' experiences, for example, how often they actually find errors using a certain procedure. General evaluations regarding double-checking, for example, frequency of interruptions during and caused by a check, or what is regarded as its essential feature was assessed. METHODS In a cross-sectional survey, qualified nurses working in oncology departments of 3 hospitals were asked to rate 5 different scenarios of double-checking procedures regarding dimensions such as frequency of use in practice and appropriateness to prevent medication errors; they were also asked general questions about double-checking. RESULTS Overall, 274 nurses (70% response rate) participated in the survey. The procedure of jointly double-checking (read-read back) was most commonly used (69% of respondents) and rated as very appropriate to prevent medication errors. Jointly checking medication was seen as the essential characteristic of double-checking-more frequently than 'carrying out checks independently' (54% vs 24%). Most nurses (78%) found the frequency of double-checking in their department appropriate. Being interrupted in one's own current activity for supporting a double-check was reported to occur frequently. Regression analysis revealed a strong preference towards checks that are currently implemented at the responders' workplace. CONCLUSIONS Double-checking is well regarded by oncology nurses as a procedure to help prevent errors, with jointly checking being used most frequently. Our results show that the notion of independent checking needs to be transferred more actively into clinical practice. The high frequency of reported interruptions during and caused by double-checks is of concern.

Full scale test for explosion water barriers in small cross-section galleries

Underground coal mines explosions generally arise from the inflammation of a methane/air mixture. This explosion can also generate a subsequent coal dust explosion. Traditionally such explosions have being fought eliminating one or several of the factors needed by the explosion to take place. Although several preventive measures are taken to prevent explosions, other measures should be considered to reduce the effects or even to extinguish the flame front. Unlike other protection methods that remove one or two of the explosion triangle elements, namely; the ignition source, the oxidizing agent and the fuel, explosion barriers removes all of them: reduces the quantity of coal in suspension, cools the flame front and the steam generated by vaporization removes the oxygen present in the flame. Passive water barriers are autonomous protection systems against explosions that reduce to a satisfactory safety level the effects of methane and/or flammable dust explosions. The barriers are activated by the pressure wave provoked in the explosion destroying the barrier troughs and producing a uniform dispersion of the extinguishing agent throughout the gallery section in quantity enough to extinguish the explosion flame. Full scale tests have been carried out in Polish Barbara experimental mine at GIG Central Mining Institute in order to determine the requirements and the optimal installation conditions of these devices for small sections galleries which are very frequent in the Spanish coal mines. Full scale tests results have been analyzed to understand the explosion timing and development, in order to assess on the use of water barriers in the typical small crosssection Spanish galleries. Several arrangements of water barriers have been designed and tested to verify the effectiveness of the explosion suppression in each case. The results obtained demonstrate the efficiency of the water barriers in stopping the flame front even with smaller amounts of water than those established by the European standard. According to the tests realized, water barriers activation times are between 0.52 s and 0.78 s and the flame propagation speed are between 75 m/s and 80 m/s. The maximum pressures (Pmax) obtained in the full scale tests have varied between 0.2 bar and 1.8 bar. Passive barriers protect effectively against the spread of the flame but cannot be used as a safeguard of the gallery between the ignition source and the first row of water troughs or bags, or even after them, as the pressure could remain high after them even if the flame front has been extinguished.

The involvement of thaumatin-like proteins in plant food cross-reactivity: a multicenter study using a specific protein microarray.

Cross-reactivity of plant foods is an important phenomenon in allergy, with geographical variations with respect to the number and prevalence of the allergens involved in this process, whose complexity requires detailed studies. We have addressed the role of thaumatin-like proteins (TLPs) in cross-reactivity between fruit and pollen allergies. A representative panel of 16 purified TLPs was printed onto an allergen microarray. The proteins selected belonged to the sources most frequently associated with peach allergy in representative regions of Spain. Sera from two groups of well characterized patients, one with allergy to Rosaceae fruit (FAG) and another against pollens but tolerant to food-plant allergens (PAG), were obtained from seven geographical areas with different environmental pollen profiles. Cross-reactivity between members of this family was demonstrated by inhibition assays. Only 6 out of 16 purified TLPs showed noticeable allergenic activity in the studied populations. Pru p 2.0201, the peach TLP (41%), chestnut TLP (24%) and plane pollen TLP (22%) proved to be allergens of probable relevance to fruit allergy, being mainly associated with pollen sensitization, and strongly linked to specific geographical areas such as Barcelona, Bilbao, the Canary Islands and Madrid. The patients exhibited mayor que50% positive response to Pru p 2.0201 and to chestnut TLP in these specific areas. Therefore, their recognition patterns were associated with the geographical area, suggesting a role for pollen in the sensitization of these allergens. Finally, the co-sensitizations of patients considering pairs of TLP allergens were analyzed by using the co-sensitization graph associated with an allergen microarray immunoassay. Our data indicate that TLPs are significant allergens in plant food allergy and should be considered when diagnosing and treating pollen-food allergy.

The effect of Windbreaks on Railway Overheads subject to Cross-Winds at O Eixo Viaduct

A measurement investigation, at ADIF's test site at the O Eixo viaduct which is on the Spanish Santiago-Ourense high speed railway line, has been carried out during the last year. The main goal of the investigation is to study the effect of the cross-wind on railway overheads (catenaries) and the influence of the presence of windbreaks on the wind-induced motion of the railway overhead. A description of the O Eixo viaduct test site is presented in this paper, including the installed windbreaks, the sensor and power supply systems. Three catenary spans has been instrumented at the center point of the catenary span contact wire with one ultrasonic anemometer and two unidirectional accelerometers. Additionally, another ultrasonic anemometer placed in the central catenary span has been installed to provide reference wind data. Wind roses of wind speed and standard deviation of the accelerometers are presented. As expected, the four wind roses look very similar and the two dominant directions close to the perpendicular to the bridge longitudinal axes, north and south have been identified. The wind roses of the standard deviation of the acceleration shows that the acceleration of the catenary contact wire is related to the directions of the two dominant winds. The vertical standard deviation of the acceleration is higher than the horizontal one for the spans with windbreaks. It has also been observed that the presence of the windbreaks modifies the wind flow leading to a wind-induced motion of the catenary contact wire which shows a higher variability than the corresponding unprotected case. On the one hand, the baseline southerly wind configuration (south wind, windbreaks in the windward side and catenary in the leeward side) influence both the mean speed at the catenary and the turbulence intensity. On the other hand, the northerly wind configuration, windbreaks in the leeward side and catenary in the windward side, provide a reference to the response of the catenary for an unprotected railway overhead, and, as it is expected, the windbreak influence is much more reduced compared to the southerly wind configuration. Both the height of the windbreak and the eaves contribute to the increase in the turbulence intensity at the catenary contact wire height. It can be seen that the height of the windbreak plays a crucial role in the increase of turbulence intensity, much more intense than the presence of the windbreak eave.

Design and Validation of an Optimized MB-OFDM Ultra Wideband Transceiver System

Esta tesis está incluida dentro del campo del campo de Multiband Orthogonal Frequency Division Multiplexing Ultra Wideband (MB-OFDM UWB), el cual ha adquirido una gran importancia en las comunicaciones inalámbricas de alta tasa de datos en la última década. UWB surgió con el objetivo de satisfacer la creciente demanda de conexiones inalámbricas en interiores y de uso doméstico, con bajo coste y alta velocidad. La disponibilidad de un ancho de banda grande, el potencial para alta velocidad de transmisión, baja complejidad y bajo consumo de energía, unido al bajo coste de implementación, representa una oportunidad única para que UWB se convierta en una solución ampliamente utilizada en aplicaciones de Wireless Personal Area Network (WPAN). UWB está definido como cualquier transmisión que ocupa un ancho de banda de más de 20% de su frecuencia central, o más de 500 MHz. En 2002, la Comisión Federal de Comunicaciones (FCC) definió que el rango de frecuencias de transmisión de UWB legal es de 3.1 a 10.6 GHz, con una energía de transmisión de -41.3 dBm/Hz. Bajo las directrices de FCC, el uso de la tecnología UWB puede aportar una enorme capacidad en las comunicaciones de corto alcance. Considerando las ecuaciones de capacidad de Shannon, incrementar la capacidad del canal requiere un incremento lineal en el ancho de banda, mientras que un aumento similar de la capacidad de canal requiere un aumento exponencial en la energía de transmisión. En los últimos años, s diferentes desarrollos del UWB han sido extensamente estudiados en diferentes áreas, entre los cuales, el protocolo de comunicaciones inalámbricas MB-OFDM UWB está considerado como la mejor elección y ha sido adoptado como estándar ISO/IEC para los WPANs. Combinando la modulación OFDM y la transmisión de datos utilizando las técnicas de salto de frecuencia, el sistema MB-OFDM UWB es capaz de soportar tasas de datos con que pueden variar de los 55 a los 480 Mbps, alcanzando una distancia máxima de hasta 10 metros. Se esperara que la tecnología MB-OFDM tenga un consumo energético muy bajo copando un are muy reducida en silicio, proporcionando soluciones de bajo coste que satisfagan las demandas del mercado. Para cumplir con todas estas expectativas, el desarrollo y la investigación del MBOFDM UWB deben enfrentarse a varios retos, como son la sincronización de alta sensibilidad, las restricciones de baja complejidad, las estrictas limitaciones energéticas, la escalabilidad y la flexibilidad. Tales retos requieren un procesamiento digital de la señal de última generación, capaz de desarrollar sistemas que puedan aprovechar por completo las ventajas del espectro UWB y proporcionar futuras aplicaciones inalámbricas en interiores. Esta tesis se centra en la completa optimización de un sistema de transceptor de banda base MB-OFDM UWB digital, cuyo objetivo es investigar y diseñar un subsistema de comunicación inalámbrica para la aplicación de las Redes de Sensores Inalámbricas Visuales. La complejidad inherente de los procesadores FFT/IFFT y el sistema de sincronización así como la alta frecuencia de operación para todos los elementos de procesamiento, se convierten en el cuello de la botella para el diseño y la implementación del sistema de UWB digital en base de banda basado en MB-OFDM de baja energía. El objetivo del transceptor propuesto es conseguir baja energía y baja complejidad bajo la premisa de un alto rendimiento. Las optimizaciones están realizadas tanto a nivel algorítmico como a nivel arquitectural para todos los elementos del sistema. Una arquitectura hardware eficiente en consumo se propone en primer lugar para aquellos módulos correspondientes a núcleos de computación. Para el procesado de la Transformada Rápida de Fourier (FFT/IFFT), se propone un algoritmo mixed-radix, basado en una arquitectura con pipeline y se ha desarrollado un módulo de Decodificador de Viterbi (VD) equilibrado en coste-velocidad con el objetivo de reducir el consumo energético e incrementar la velocidad de procesamiento. También se ha implementado un correlador signo-bit simple basado en la sincronización del tiempo de símbolo es presentado. Este correlador es usado para detectar y sincronizar los paquetes de OFDM de forma robusta y precisa. Para el desarrollo de los subsitemas de procesamiento y realizar la integración del sistema completo se han empleado tecnologías de última generación. El dispositivo utilizado para el sistema propuesto es una FPGA Virtex 5 XC5VLX110T del fabricante Xilinx. La validación el propuesta para el sistema transceptor se ha implementado en dicha placa de FPGA. En este trabajo se presenta un algoritmo, y una arquitectura, diseñado con filosofía de co-diseño hardware/software para el desarrollo de sistemas de FPGA complejos. El objetivo principal de la estrategia propuesta es de encontrar una metodología eficiente para el diseño de un sistema de FPGA configurable optimizado con el empleo del mínimo esfuerzo posible en el sistema de procedimiento de verificación, por tanto acelerar el periodo de desarrollo del sistema. La metodología de co-diseño presentada tiene la ventaja de ser fácil de usar, contiene todos los pasos desde la propuesta del algoritmo hasta la verificación del hardware, y puede ser ampliamente extendida para casi todos los tipos de desarrollos de FPGAs. En este trabajo se ha desarrollado sólo el sistema de transceptor digital de banda base por lo que la comprobación de señales transmitidas a través del canal inalámbrico en los entornos reales de comunicación sigue requiriendo componentes RF y un front-end analógico. No obstante, utilizando la metodología de co-simulación hardware/software citada anteriormente, es posible comunicar el sistema de transmisor y el receptor digital utilizando los modelos de canales propuestos por IEEE 802.15.3a, implementados en MATLAB. Por tanto, simplemente ajustando las características de cada modelo de canal, por ejemplo, un incremento del retraso y de la frecuencia central, podemos estimar el comportamiento del sistema propuesto en diferentes escenarios y entornos. Las mayores contribuciones de esta tesis son: • Se ha propuesto un nuevo algoritmo 128-puntos base mixto FFT usando la arquitectura pipeline multi-ruta. Los complejos multiplicadores para cada etapa de procesamiento son diseñados usando la arquitectura modificada shiftadd. Los sistemas word length y twiddle word length son comparados y seleccionados basándose en la señal para cuantización del SQNR y el análisis de energías. • El desempeño del procesador IFFT es analizado bajo diferentes situaciones aritméticas de bloques de punto flotante (BFP) para el control de desbordamiento, por tanto, para encontrar la arquitectura perfecta del algoritmo IFFT basado en el procesador FFT propuesto. • Para el sistema de receptor MB-OFDM UWB se ha empleado una sincronización del tiempo innovadora, de baja complejidad y esquema de compensación, que consiste en funciones de Detector de Paquetes (PD) y Estimación del Offset del tiempo. Simplificando el cross-correlation y maximizar las funciones probables solo a sign-bit, la complejidad computacional se ve reducida significativamente. • Se ha propuesto un sistema de decodificadores Viterbi de 64 estados de decisión-débil usando velocidad base-4 de arquitectura suma-comparaselecciona. El algoritmo Two-pointer Even también es introducido en la unidad de rastreador de origen con el objetivo de conseguir la eficiencia en el hardware. • Se han integrado varias tecnologías de última generación en el completo sistema transceptor basebanda , con el objetivo de implementar un sistema de comunicación UWB altamente optimizado. • Un diseño de flujo mejorado es propuesto para el complejo sistema de implementación, el cual puede ser usado para diseños de Cadena de puertas de campo programable general (FPGA). El diseño mencionado no sólo reduce dramáticamente el tiempo para la verificación funcional, sino también provee un análisis automático como los errores del retraso del output para el sistema de hardware implementado. • Un ambiente de comunicación virtual es establecido para la validación del propuesto sistema de transceptores MB-OFDM. Este método es provisto para facilitar el uso y la conveniencia de analizar el sistema digital de basebanda sin parte frontera analógica bajo diferentes ambientes de comunicación. Esta tesis doctoral está organizada en seis capítulos. En el primer capítulo se encuentra una breve introducción al campo del UWB, tanto relacionado con el proyecto como la motivación del desarrollo del sistema de MB-OFDM. En el capítulo 2, se presenta la información general y los requisitos del protocolo de comunicación inalámbrica MBOFDM UWB. En el capítulo 3 se habla de la arquitectura del sistema de transceptor digital MB-OFDM de banda base . El diseño del algoritmo propuesto y la arquitectura para cada elemento del procesamiento está detallado en este capítulo. Los retos de diseño del sistema que involucra un compromiso de discusión entre la complejidad de diseño, el consumo de energía, el coste de hardware, el desempeño del sistema, y otros aspectos. En el capítulo 4, se ha descrito la co-diseñada metodología de hardware/software. Cada parte del flujo del diseño será detallado con algunos ejemplos que se ha hecho durante el desarrollo del sistema. Aprovechando esta estrategia de diseño, el procedimiento de comunicación virtual es llevado a cabo para probar y analizar la arquitectura del transceptor propuesto. Los resultados experimentales de la co-simulación y el informe sintético de la implementación del sistema FPGA son reflejados en el capítulo 5. Finalmente, en el capítulo 6 se incluye las conclusiones y los futuros proyectos, y también los resultados derivados de este proyecto de doctorado. ABSTRACT In recent years, the Wireless Visual Sensor Network (WVSN) has drawn great interest in wireless communication research area. They enable a wealth of new applications such as building security control, image sensing, and target localization. However, nowadays wireless communication protocols (ZigBee, Wi-Fi, and Bluetooth for example) cannot fully satisfy the demands of high data rate, low power consumption, short range, and high robustness requirements. New communication protocol is highly desired for such kind of applications. The Ultra Wideband (UWB) wireless communication protocol, which has increased in importance for high data rate wireless communication field, are emerging as an important topic for WVSN research. UWB has emerged as a technology that offers great promise to satisfy the growing demand for low-cost, high-speed digital wireless indoor and home networks. The large bandwidth available, the potential for high data rate transmission, and the potential for low complexity and low power consumption, along with low implementation cost, all present a unique opportunity for UWB to become a widely adopted radio solution for future Wireless Personal Area Network (WPAN) applications. UWB is defined as any transmission that occupies a bandwidth of more than 20% of its center frequency, or more than 500 MHz. In 2002, the Federal Communications Commission (FCC) has mandated that UWB radio transmission can legally operate in the range from 3.1 to 10.6 GHz at a transmitter power of －41.3 dBm/Hz. Under the FCC guidelines, the use of UWB technology can provide enormous capacity over short communication ranges. Considering Shannon’s capacity equations, increasing the channel capacity requires linear increasing in bandwidth, whereas similar channel capacity increases would require exponential increases in transmission power. In recent years, several different UWB developments has been widely studied in different area, among which, the MB-OFDM UWB wireless communication protocol is considered to be the leading choice and has recently been adopted in the ISO/IEC standard for WPANs. By combing the OFDM modulation and data transmission using frequency hopping techniques, the MB-OFDM UWB system is able to support various data rates, ranging from 55 to 480 Mbps, over distances up to 10 meters. The MB-OFDM technology is expected to consume very little power and silicon area, as well as provide low-cost solutions that can satisfy consumer market demands. To fulfill these expectations, MB-OFDM UWB research and development have to cope with several challenges, which consist of high-sensitivity synchronization, low- complexity constraints, strict power limitations, scalability, and flexibility. Such challenges require state-of-the-art digital signal processing expertise to develop systems that could fully take advantages of the UWB spectrum and support future indoor wireless applications. This thesis focuses on fully optimization for the MB-OFDM UWB digital baseband transceiver system, aiming at researching and designing a wireless communication subsystem for the Wireless Visual Sensor Networks (WVSNs) application. The inherent high complexity of the FFT/IFFT processor and synchronization system, and high operation frequency for all processing elements, becomes the bottleneck for low power MB-OFDM based UWB digital baseband system hardware design and implementation. The proposed transceiver system targets low power and low complexity under the premise of high performance. Optimizations are made at both algorithm and architecture level for each element of the transceiver system. The low-power hardwareefficient structures are firstly proposed for those core computation modules, i.e., the mixed-radix algorithm based pipelined architecture is proposed for the Fast Fourier Transform (FFT/IFFT) processor, and the cost-speed balanced Viterbi Decoder (VD) module is developed, in the aim of lowering the power consumption and increasing the processing speed. In addition, a low complexity sign-bit correlation based symbol timing synchronization scheme is presented so as to detect and synchronize the OFDM packets robustly and accurately. Moreover, several state-of-the-art technologies are used for developing other processing subsystems and an entire MB-OFDM digital baseband transceiver system is integrated. The target device for the proposed transceiver system is Xilinx Virtex 5 XC5VLX110T FPGA board. In order to validate the proposed transceiver system in the FPGA board, a unified algorithm-architecture-circuit hardware/software co-design environment for complex FPGA system development is presented in this work. The main objective of the proposed strategy is to find an efficient methodology for designing a configurable optimized FPGA system by using as few efforts as possible in system verification procedure, so as to speed up the system development period. The presented co-design methodology has the advantages of easy to use, covering all steps from algorithm proposal to hardware verification, and widely spread for almost all kinds of FPGA developments. Because only the digital baseband transceiver system is developed in this thesis, the validation of transmitting signals through wireless channel in real communication environments still requires the analog front-end and RF components. However, by using the aforementioned hardware/software co-simulation methodology, the transmitter and receiver digital baseband systems get the opportunity to communicate with each other through the channel models, which are proposed from the IEEE 802.15.3a research group, established in MATLAB. Thus, by simply adjust the characteristics of each channel model, e.g. mean excess delay and center frequency, we can estimate the transmission performance of the proposed transceiver system through different communication situations. The main contributions of this thesis are: • A novel mixed radix 128-point FFT algorithm by using multipath pipelined architecture is proposed. The complex multipliers for each processing stage are designed by using modified shift-add architectures. The system wordlength and twiddle word-length are compared and selected based on Signal to Quantization Noise Ratio (SQNR) and power analysis. • IFFT processor performance is analyzed under different Block Floating Point (BFP) arithmetic situations for overflow control, so as to find out the perfect architecture of IFFT algorithm based on the proposed FFT processor. • An innovative low complex timing synchronization and compensation scheme, which consists of Packet Detector (PD) and Timing Offset Estimation (TOE) functions, for MB-OFDM UWB receiver system is employed. By simplifying the cross-correlation and maximum likelihood functions to signbit only, the computational complexity is significantly reduced. • A 64 state soft-decision Viterbi Decoder system by using high speed radix-4 Add-Compare-Select architecture is proposed. Two-pointer Even algorithm is also introduced into the Trace Back unit in the aim of hardware-efficiency. • Several state-of-the-art technologies are integrated into the complete baseband transceiver system, in the aim of implementing a highly-optimized UWB communication system. • An improved design flow is proposed for complex system implementation which can be used for general Field-Programmable Gate Array (FPGA) designs. The design method not only dramatically reduces the time for functional verification, but also provides automatic analysis such as errors and output delays for the implemented hardware systems. • A virtual communication environment is established for validating the proposed MB-OFDM transceiver system. This methodology is proved to be easy for usage and convenient for analyzing the digital baseband system without analog frontend under different communication environments. This PhD thesis is organized in six chapters. In the chapter 1 a brief introduction to the UWB field, as well as the related work, is done, along with the motivation of MBOFDM system development. In the chapter 2, the general information and requirement of MB-OFDM UWB wireless communication protocol is presented. In the chapter 3, the architecture of the MB-OFDM digital baseband transceiver system is presented. The design of the proposed algorithm and architecture for each processing element is detailed in this chapter. Design challenges of such system involve trade-off discussions among design complexity, power consumption, hardware cost, system performance, and some other aspects. All these factors are analyzed and discussed. In the chapter 4, the hardware/software co-design methodology is proposed. Each step of this design flow will be detailed by taking some examples that we met during system development. Then, taking advantages of this design strategy, the Virtual Communication procedure is carried out so as to test and analyze the proposed transceiver architecture. Experimental results from the co-simulation and synthesis report of the implemented FPGA system are given in the chapter 5. The chapter 6 includes conclusions and future work, as well as the results derived from this PhD work.