A Distributed Multi-Tier Emergency Alerting System Exploiting Sensors-Based Event Detection to Support Smart City Applications

The development of efficient sensing technologies and the maturation of the Internet of Things (IoT) paradigm and related protocols have considerably fostered the expansion of sensor-based monitoring applications. A great number of those applications has been developed to monitor a set of information for better perception of the environment, with some of them being dedicated to identifying emergency situations. Current IoT-based emergency systems have limitations when considering the broader scope of smart cities, exploiting one or just a few monitoring variables or even allocating high computational burden to regular sensor nodes. In this context, we propose a distributed multi-tier emergency alerting system built around a number of sensor-based event detection units, providing real-time georeferenced information about the occurrence of critical events, while taking as input a configurable number of different scalar sensors and GPS data. The proposed system could then be used to detect and to deliver emergency alarms, which are computed based on the detected events, the previously known risk level of the affected areas and temporal information. Doing so, modularized and flexible perceptions of critical events are provided, according to the particularities of each considered smart city scenario. Besides implementing the proposed system in open-source electronic platforms, we also created a real-time visualization application to dynamically display emergency alarms on a map, demonstrating a feasible and useful application of the system as a supporting service. Therefore, this innovative approach and its corresponding physical implementation can bring valuable results for smart cities, potentially supporting the development of adaptive IoT-based emergency-aware applications.

Influence of body mass index in anti-Müllerian hormone levels in 951 non-polycystic ovarian syndrome women followed at a reproductive medicine unit

PURPOSE

Anti-Müllerian hormone (AMH) is a useful marker of ovarian reserve. Obesity/overweight are increasing and may affect the reproductive health. Previous studies regarding the effect of body mass index (BMI) on AMH levels are discordant. Our main goal was to evaluate the influence of BMI on AMH levels in women without polycystic ovarian syndrome.

METHODS

Revision of medical records of 951 women who performed AMH determinations as part of their fertility workup, between 2011 and 2016.

RESULTS

Median AMH concentration was 1.75 [interquartile range (IQR) 2] ng/mL (12.9 pmol/mL) and median age at AMH determination was 35 (IQR 6) years. These women evidenced a median BMI of 23 (IQR 5) kg/m². Caucasian women were more represented [889(89.3%)]. Smoking habits (present/past) were present in 359(36.1%), and 147(14.8%) harboured a history of ovarian surgery. On univariable analysis AMH was not correlated with BMI (r = 0.048/p = 0.135); the only factors influencing AMH were age (p < 0.001), ethnicity (p = 0.004), and previous ovarian surgery (p < 0.001). On multivariable analysis, age was the only variable significantly associated with AMH, evidencing a reduction of 6.2% for each additional year (p < 0.0001). Furthermore, we verified a trend suggesting an AMH reduction of 22% (p = 0.08) in black patients comparing with the caucasian ones, when controlling for the other variables.

CONCLUSION

We report one of the largest series evaluating the influence of BMI on AMH levels and, consequently, on ovarian reserve. BMI does not seem to affect AMH levels. The reported concerns on infertility in overweight and obese women may be related to follicular development/oocyte maturation or endometrial disorders, rather than decreased ovarian reserve.

Heart rate variability metrics for fine-grained stress level assessment

BACKGROUND AND OBJECTIVES

In spite of the existence of a multitude of techniques that allow the estimation of stress from physiological indexes, its fine-grained assessment is still a challenge for biomedical engineering. The short-term assessment of stress condition overcomes the limits to stress characterization with long blocks of time and allows to evaluate the behaviour change in real-world settings and also the stress level dynamics. The aim of the present study was to evaluate time and frequency domain and nonlinear heart rate variability (HRV) metrics for stress level assessment using a short-time window.

METHODS

The electrocardiogram (ECG) signal from 14 volunteers was monitored using the Vital Jacket^TM while they performed the Trier Social Stress Test (TSST) which is a standardized stress-inducing protocol. Window lengths from 220 s to 50 s for HRV analysis were tested in order to evaluate which metrics could be used to monitor stress levels in an almost continuous way.

RESULTS

A sub-set of HRV metrics (AVNN, rMSSD, SDNN and pNN20) showed consistent differences between stress and non-stress phases, and showed to be reliable parameters for the assessment of stress levels in short-term analysis.

CONCLUSIONS

The AVNN metric, using 50 s of window length analysis, showed that it is the most reliable metric to recognize stress level across the four phases of TSST and allows a fine-grained analysis of stress effect as an index of psychological stress and provides an insight into the reaction of the autonomic nervous system to stress.

Regulation Disorders of Sensory Processing–Understanding the Complexities of Child-parents Relationship

Introduction

Many authors have agreed on the clinical importance of sensory regulation for a child's cognitive, affective and social development. Sensory regulation abilities are fundamental for an efficient modulation of internal states and the development of appropriately graded responses to the constantly changing sensory experiences. Sensory modulation deficit is an essential feature of regulation disorders of sensory processing (RDSP), that is characterized by difficulties in regulating emotions, behaviors and motor abilities, in response to sensory stimulation and lead to impairment in functioning. We also know that, through daily interactions and early relationship (child's attachment), parents play a crucial role on child's regulation in terms of their emotional and physical availability and how they interpret and respond to child needs.

Objective

The authors will present a clinical case of a two-year child who has been diagnosed with RDSP, highlighting the main features, types (hypersensitive; hyposensitive/under-responsive; sensory-stimulation seeking/impulsive) and challenges of this disturb.

Aims

Explore the association between sensory regulation difficulties, RDSP and child attachment.

Methods

Systematic literature review.

Results

Recent studies showed the high prevalence of sensory regulation difficulties (33–76%) and insecure attachment (80%) in children with psychiatric disorders. Results also revealed that children with greater sensory impairment were significantly more likely to show elevated scores of insecurity (avoidance and dependence) to their caregiver.

Conclusions

This work underscores the caregiver's role as a facilitator of child integration and response to sensory stimuli and its importance on the development of behavioral and emotional disorders. This can help early diagnosis and better treatment who prevent future psychiatric conditions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Short and Long-Term Efficacy of Laparoscopic Ovarian Diathermy in Women with Polycystic Ovary Syndrome

INTRODUCTION

Polycystic ovary syndrome is the most frequent cause of anovulatory infertility and management involves a multistep approach. Laparoscopic ovarian diathermy is accepted as a second-line treatment of patients who failed to respond to clomiphene citrate. The aims of this study were to determine the efficacy of this technique at short and long-term and to perform an analysis of predictive factors of spontaneous pregnancy.

MATERIAL AND METHODS

This retrospective study involved 76 women who underwent laparoscopic ovarian diathermy between 2004 and 2013 in a university hospital. Main outcomes were cycle regularity and pregnancy. Short-term outcomes recorded during followup in our centre were reviewed and long-term outcomes were evaluated by a telephone interview to all women whose surgery was undertaken more than three years ago. Clinical and biochemical data were analysed as predictive factors of spontaneous conceptionin patients without other infertility factors.

RESULTS

Menstrual cycle regularity was initially achieved in 53 (70%) women and in the long-term follow-up subgroup, 52% (12/23) had regular periods. In general, 53 (70%) women conceived and 77 pregnancies were achieved, 60% of which were spontaneous. The only prognostic factor found to be significantly associated with spontaneous conception was a shorter duration of infertility (< 3 years) (p < 0.05).

DISCUSSION

Laparoscopic ovarian diathermy showed pregnancy rates comparable to other ovulation induction treatments with the advantage of having a long lasting beneficial effect in menstrual regularity and fertility.

CONCLUSION

Laparoscopic ovarian diathermy is a safe and effective treatment option for anovulatory infertility in women with polycystic ovary syndrome.

Clinico-biochemical characteristics of 229 Portuguese infertile women with polycystic ovary syndrome: clinical relevance and relationship with fertility treatment results

PURPOSE

Polycystic ovary syndrome (PCOS) affects 6-20% of reproductive-age women. The authors aimed to evaluate the characteristics of PCOS women and its relationship with fertility treatment outcomes.

MATERIALS AND METHODS

The authors reviewed records of PCOS women assisted at Hospital Santa Maria. Fertility treatment results were assessed as pregnancy rate, number of cycles, and miscarriage rate.

RESULTS

They identified 229 PCOS women, 179 (78.2%) had waist circumference > 80 cm, 72 (31.4%) had type 2 diabetes mellitus (T2DM) familial history and glucose abnormalities, hypertriglyceridemia and low cholesterol-HDL were detected in 23(10.1%), 15 (6.6%) and 103 (45.0%), respectively. Pregnancy was achieved in 164 women. The mean number of cycles to achieve pregnancy was 2.7 (±2.2). Statistical analysis identified factors associated with longer/higher number of treatments: primary infertility, T2DM familial history, hypertriglyceridemia, and low cholesterol-HDL. Waist circumference > 80 cm, older age, and increased LH level were associated with miscarriage.

CONCLUSIONS

Primary infertility, T2DM familial history, hypertriglyceridemia, low cholesterol-HDL, older age, waist circumference > 80 cm, and high LH may confer poorer fertility treatment results.

Helminth parasite communities of two Physalaemus cuvieri Fitzinger, 1826 (Anura: Leiuperidae) populations under different conditions of habitat integrity in the Atlantic Rain Forest of Brazil

Adults of Physalaemus cuvieri were collected and necropsied between November 2009 and January 2010. This was carried out in order to report and compare the helminth fauna associated with two populations of this anuran species from the Brazilian Atlantic rain forest under different conditions of habitat integrity. The hosts from the disturbed area were parasitized with five helminth taxa: Cosmocerca parva, Aplectana sp., Physaloptera sp., Rhabdias sp., Oswaldocruzia subauricularis (Nematoda) and Polystoma cuvieri (Monogenea) while those from the preserved area had four helminth taxa: C. parva, Aplectana sp., Physaloptera sp., Rhabdias sp., and Acanthocephalus saopaulensis (Acanthocephala). Prevalence, mean intensity of infection, mean abundance, mean richness, importance index and dominance frequency of helminth component communities were similar in both areas. The helminth community associated with anurans from the disturbed area had higher diversity than that from the preserved area. This study is the first to report on the acanthocephalan parasites of Ph. cuvieri, and the similarity between helminth fauna composition of two host populations under different selective pressures.

Practices in prescribing protein substitutes for PKU in Europe: No uniformity of approach

BACKGROUND

There appears little consensus concerning protein requirements in phenylketonuria (PKU).

METHODS

A questionnaire completed by 63 European and Turkish IMD centres from 18 countries collected data on prescribed total protein intake (natural/intact protein and phenylalanine-free protein substitute [PS]) by age, administration frequency and method, monitoring, and type of protein substitute. Data were analysed by European region using descriptive statistics.

RESULTS

The amount of total protein (from PS and natural/intact protein) varied according to the European region. Higher median amounts of total protein were prescribed in infants and children in Northern Europe (n=24 centres) (infants <1 year, >2-3g/kg/day; 1-3 years of age, >2-3 g/kg/day; 4-10 years of age, >1.5-2.5 g/kg/day) and Southern Europe (n=10 centres) (infants <1 year, 2.5 g/kg/day, 1-3 years of age, 2 g/kg/day; 4-10 years of age, 1.5-2 g/kg/day), than by Eastern Europe (n=4 centres) (infants <1 year, 2.5 g/kg/day, 1-3 years of age, >2-2.5 g/kg/day; 4-10 years of age, >1.5-2 g/kg/day) and with Western Europe (n=25 centres) giving the least (infants <1 year, >2-2.5 g/kg/day, 1-3 years of age, 1.5-2 g/kg/day; 4-10 years of age, 1-1.5 g/kg/day). Total protein prescription was similar in patients aged >10 years (1-1.5 g/kg/day) and maternal patients (1-1.5 g/kg/day).

CONCLUSIONS

The amounts of total protein prescribed varied between European countries and appeared to be influenced by geographical region. In PKU, all gave higher than the recommended 2007 WHO/FAO/UNU safe levels of protein intake for the general population.

Does fungicide application in vineyards induce resistance to medical azoles in Aspergillus species?

This study assessed if the use of sterol demethylase inhibitor fungicides in vineyard production can induce resistance to azoles in Aspergillus strains and if it can induce selection of resistant species. We also tried to identify the Aspergillus species most prevalent in the vineyards. Two vineyards from northern Portugal were selected from "Vinhos Verdes" and "Douro" regions. The vineyards were divided into plots that were treated or not with penconazole (PEN). In each vineyard, air, soil, and plant samples were collected at three different times. The strains of Aspergillus spp. were isolated and identified by morphological and molecular techniques. We identified 46 Aspergillus section Nigri, eight Aspergillus fumigatus, seven Aspergillus lentulus, four Aspergillus wentii, two Aspergillus flavus, two Aspergillus terreus, one Aspergillus calidoustus, one Aspergillus westerdijkiae, one Aspergillus tamarii, and one Eurotium amstelodami. Aspergillus strains were evaluated for their susceptibility to medical azoles used in human therapy (itraconazole, posaconazole, and voriconazole) and to agricultural azoles (PEN) used in the prevention and treatment of plant diseases. The isolates showed moderate susceptibility to voriconazole. We did not observe any decrease of susceptibility to the medical azoles tested throughout the testing period in any of the treated plots, although some of the resistant species were isolated from there.

Clinicopathological differences between interval and screen-detected breast cancers diagnosed within a screening programme in Northern Portugal

Objective

To evaluate clinicopathological differences between screen-detected (SD) and interval (IC) breast cancers diagnosed in women enrolled in an organized breast screening programme in 2000--2007.

Setting

Breast Cancer Screening Programme of the north region of Portugal.

Methods

Using data from the screening programme and from the population-based North Region Cancer Registry, SD and IC were identified. Information on screening history, age, date of diagnosis, tumour size, histological type and grade, lymph node status, tumour stage, biomarkers, and treatment was obtained from the cancer registry and from clinical and pathological reports. Association between mode of detection and these clinicopathological characteristics was estimated by unconditional logistic regression.

Results

A total of 442 SD and 112 IC were identified in women aged 50--69. Compared with SD, IC were diagnosed in younger women (60.0 ± 5.8 years and 58.4 ± 6.0 years, respectively), were larger (tumour size >20 mm: 60.2% versus 25.1%), lobular (6.3% versus 16.1%), with a higher differentiation grade (grade 3: 17.7% versus 38.9%), had more lymph node metastases, more advanced stage, and oestrogen receptor (ER) negative (12.9% versus 29.0%) and progesterone negative, and HER2 positive. After multivariable analysis, compared with SD, IC were more likely to be larger than 20 mm, lobular, of grade 3 and negative for ER.

Conclusion

Our results are consistent with other studies. IC’s have a more aggressive biology than SDs. Our findings did not show any unexpected pattern requiring changes to our screening procedures, but continuous identification and characterization of IC is advisable.