Improvement of antibiotic prescription in outpatient care: a cluster-randomized intervention study using a sentinel surveillance network of physicians.

OBJECTIVES: To assess the effectiveness of implementing guidelines, coupled with individual feedback, on antibiotic prescribing behaviour of primary care physicians in Switzerland. METHODS: One hundred and forty general practices from a representative Swiss sentinel network of primary care physicians participated in this cluster-randomized prospective intervention study. The intervention consisted of providing guidelines on treatment of respiratory tract infections (RTIs) and uncomplicated lower urinary tract infections (UTIs), coupled with sustained, regular feedback on individual antibiotic prescription behaviour during 2 years. The main aims were: (i) to increase the percentage of prescriptions of penicillins for all RTIs treated with antibiotics; (ii) to increase the percentage of trimethoprim/sulfamethoxazole prescriptions for all uncomplicated lower UTIs treated with antibiotics; (iii) to decrease the percentage of quinolone prescriptions for all cases of exacerbated COPD (eCOPD) treated with antibiotics; and (iv) to decrease the proportion of sinusitis and other upper RTIs treated with antibiotics. The study was registered at ClinicalTrials.gov (NCT01358916). RESULTS: While the percentage of antibiotics prescribed for sinusitis or other upper RTIs and the percentage of quinolones prescribed for eCOPD did not differ between the intervention group and the control group, there was a significant increase in the percentage of prescriptions of penicillins for all RTIs treated with antibiotics [57% versus 49%, OR=1.42 (95% CI 1.08-1.89), P=0.01] and in the percentage of trimethoprim/sulfamethoxazole prescriptions for all uncomplicated lower UTIs treated with antibiotics [35% versus 19%, OR=2.16 (95% CI 1.19-3.91), P=0.01] in the intervention group. CONCLUSIONS: In our setting, implementing guidelines, coupled with sustained individual feedback, was not able to reduce the proportion of sinusitis and other upper RTIs treated with antibiotics, but increased the use of recommended antibiotics for RTIs and UTIs, as defined by the guidelines.

QoS online routing and MPLS multilevel protection: a survey

A survey of MPLS protection methods and their utilization in combination with online routing methods is presented in this article. Usually, fault management methods pre-establish backup paths to recover traffic after a failure. In addition, MPLS allows the creation of different backup types, and hence MPLS is a suitable method to support traffic-engineered networks. In this article, an introduction of several label switch path backup types and their pros and cons are pointed out. The creation of an LSP involves a routing phase, which should include QoS aspects. In a similar way, to achieve a reliable network the LSP backups must also be routed by a QoS routing method. When LSP creation requests arrive one by one (a dynamic network scenario), online routing methods are applied. The relationship between MPLS fault management and QoS online routing methods is unavoidable, in particular during the creation of LSP backups. Both aspects are discussed in this article. Several ideas on how these actual technologies could be applied together are presented and compared

Adding QoS protection in order to enhance MPLS QoS routing

In this paper, a method for enhancing current QoS routing methods by means of QoS protection is presented. In an MPLS network, the segments (links) to be protected are predefined and an LSP request involves, apart from establishing a working path, creating a specific type of backup path (local, reverse or global). Different QoS parameters, such as network load balancing, resource optimization and minimization of LSP request rejection should be considered. QoS protection is defined as a function of QoS parameters, such as packet loss, restoration time, and resource optimization. A framework to add QoS protection to many of the current QoS routing algorithms is introduced. A backup decision module to select the most suitable protection method is formulated and different case studies are analyzed

Experimental Modeling and Control Strategies on an Open Mobile Robot Platform PRIM

This research work deals with the problem of modeling and design of low level speed controller for the mobile robot PRIM. The main objective is to develop an effective educational tool. On one hand, the interests in using the open mobile platform PRIM consist in integrating several highly related subjects to the automatic control theory in an educational context, by embracing the subjects of communications, signal processing, sensor fusion and hardware design, amongst others. On the other hand, the idea is to implement useful navigation strategies such that the robot can be served as a mobile multimedia information point. It is in this context, when navigation strategies are oriented to goal achievement, that a local model predictive control is attained. Hence, such studies are presented as a very interesting control strategy in order to develop the future capabilities of the system

PRIM an Open Mobile Robot Platform. Motivation, Present and Future Trends

This paper is focused on the robot mobile platform PRIM (platform robot information multimedia). This robot has been made in order to cover two main needs of our group, on one hand the need for a full open mobile robotic platform that is very useful in fulfilling the teaching and research activity of our school community, and on the other hand with the idea of introducing an ethical product which would be useful as mobile multimedia information point as a service tool. This paper introduces exactly how the system is made up and explains just what the philosophy is behind this work. The navigation strategies and sensor fusion, where machine vision system is the most important one, are oriented towards goal achievement and are the key to the behaviour of the robot

Knowledge integration within an applied mobile robot summer course

This paper presents the use of a mobile robot platform as an innovative educational tool in order to promote and integrate different curriculum knowledge. Hence, it is presented the acquired experience within a summer course named ldquoapplied mobile roboticsrdquo. The main aim of the course is to integrate different subjects as electronics, programming, architecture, perception systems, communications, control and trajectory planning by using the educational open mobile robot platform PRIM. The summer course is addressed to a wide range of student profiles. However, it is of special interests to the students of electrical and computer engineering around their final academic year. The summer course consists of the theoretical and laboratory sessions, related to the following topics: design & programming of electronic devices, modelling and control systems, trajectory planning and control, and computer vision systems. Therefore, the clues for achieving a renewed path of progress in robotics are the integration of several knowledgeable fields, such as computing, communications, and control sciences, in order to perform a higher level reasoning and use decision tools with strong theoretical base

Availability analysis of GMPLS connections based on physical network topology

This paper presents a study of connection availability in GMPLS over optical transport networks (OTN) taking into account different network topologies. Two basic path protection schemes are considered and compared with the no protection case. The selected topologies are heterogeneous in geographic coverage, network diameter, link lengths, and average node degree. Connection availability is also computed considering the reliability data of physical components and a well-known network availability model. Results show several correspondences between suitable path protection algorithms and several network topology characteristics

Dynamic bandwidth management as part of an integrated network management system based on distributed agents

We present a system for dynamic network resource configuration in environments with bandwidth reservation and path restoration mechanisms. Our focus is on the dynamic bandwidth management results, although the main goal of the system is the integration of the different mechanisms that manage the reserved paths (bandwidth, restoration, and spare capacity planning). The objective is to avoid conflicts between these mechanisms. The system is able to dynamically manage a logical network such as a virtual path network in ATM or a label switch path network in MPLS. This system has been designed to be modular in the sense that in can be activated or deactivated, and it can be applied only in a sub-network. The system design and implementation is based on a multi-agent system (MAS). We also included details of its architecture and implementation

Parental influences on pathogen resistance in brown trout embryos and effects of outcrossing within a river network.

Phenotypic plasticity can increase tolerance to heterogeneous environments but the elevations and slopes of reaction norms are often population specific. Disruption of locally adapted reaction norms through outcrossing can lower individual viability. Here, we sampled five genetically distinct populations of brown trout (Salmo trutta) from within a river network, crossed them in a full-factorial design, and challenged the embryos with the opportunistic pathogen Pseudomonas fluorescens. By virtue of our design, we were able to disentangle effects of genetic crossing distance from sire and dam effects on early life-history traits. While pathogen infection did not increase mortality, it was associated with delayed hatching of smaller larvae with reduced yolk sac reserves. We found no evidence of a relationship between genetic distance (W, FST) and the expression of early-life history traits. Moreover, hybrids did not differ in phenotypic means or reaction norms in comparison to offspring from within-population crosses. Heritable variation in early life-history traits was found to remain stable across the control and pathogen environments. Our findings show that outcrossing within a rather narrow geographical scale can have neutral effects on F1 hybrid viability at the embryonic stage, i.e. at a stage when environmental and genetic effects on phenotypes are usually large.

Predictive motion control of a mirosot mobile robot

This paper discusses predictive motion control of a MiRoSoT robot. The dynamic model of the robot is deduced by taking into account the whole process - robot, vision, control and transmission systems. Based on the obtained dynamic model, an integrated predictive control algorithm is proposed to position precisely with either stationary or moving obstacle avoidance. This objective is achieved automatically by introducing distant constraints into the open-loop optimization of control inputs. Simulation results demonstrate the feasibility of such control strategy for the deduced dynamic model

Entorn de simulació per a xarxes òptiques de transport

Aquest projecte final de carrera pretén investigar i experimentar una nova línia de desenvolupament d’algorismes dinàmics. A partir de l’algorisme AntNet-QoS [2] s’ incorporen noves mesures a l’algorisme (mesura de l’amplada de banda disponible i jitter), les quals combinant amb la mesura de retard ja feta servir, permet adaptar-se millor a les condicions actuals del trànsit en la xarxa i als requeriments específics de qualitat (QoS) per part del trànsit

Disseny i implementació d’una “Storage Area Network”

El següent projecte consisteix en analitzar com funciona un sistema SAN, per tal de veure comes pot obtenir un millor rendiment. L’objectiu principal es saber com es comportarà la nostra SAN muntada amb iSCSI a través de la xarxa, volem veure quines són les operacions, les dades i els resultats que comporta crear una RAID a través de discos no locals d’un ordinador i a través d’una xarxa LAN

Sentinel network for monitoring in vitro susceptibility of Plasmodium falciparum to antimalarial drugs in Colombia: a proof of concept

Drug resistance is one of the principal obstacles blocking worldwide malaria control. In Colombia, malaria remains a major public health concern and drug-resistant parasites have been reported. In vitro drug susceptibility assays are a useful tool for monitoring the emergence and spread of drug-resistant Plasmodium falciparum. The present study was conducted as a proof of concept for an antimalarial drug resistance surveillance network based on in vitro susceptibility testing in Colombia. Sentinel laboratories were set up in three malaria endemic areas. The enzyme linked immunosorbent assay-histidine rich protein 2 and schizont maturation methods were used to assess the susceptibility of fresh P. falciparum isolates to six antimalarial drugs. This study demonstrates that an antimalarial drug resistance surveillance network based on in vitro methods is feasible in the field with the participation of a research institute, local health institutions and universities. It could also serve as a model for a regional surveillance network. Preliminary susceptibility results showed widespread chloroquine resistance, which was consistent with previous reports for the Pacific region. However, high susceptibility to dihydroartemisinin and lumefantrine compounds, currently used for treatment in the country, was also reported. The implementation process identified critical points and opportunities for the improvement of network sustainability strategies.

Desarrollo de un aplicativo mobile multiplataforma

En esta memoria se recoge toda la documentación que se genera en las etapas de desarrollo de un proyecto software: recogida inicial de requerimientos, análisis, diseño, implementación y validación. El software a desarrollar es un aplicativo mobile multiplataforma usando un framework de desarrollo ágil. El objetivo de dicha aplicación es crear una red para compartir información entre usuarios sobre el precio y la localización de los mejores souvenirs en cualquier parte del mundo.