Cardiac rehabilitation in heart failure patients with devices

Cardiac rehabilitation (CR) for heart failure by systolic dysfunction benefits from a recommendation of level IA by all the scientific societies. The main core components of CR include: evaluation, personalized physical training, patient education, treatments optimization and psycho-social counselling. Heart failure patients are sometimes, and more and more often, implanted by simple or sophisticated pacemakers, resynchronization and/or automatic defibrillators for rhythm and/or hemodynamic indications.The management of these patients requires the knowledge of the functioning of every device, constraints and limits of these and risks associated to the disease and to the equipment in different situations. The cardiologic evaluation at exercise by a cardiopulmonary exercise test will allow the prescription of the training but it happens that some adjustments of the settings are required. The demonstrated benefits of exercise training are an improvement of exercise capacities, and consequently of quality of life and also a reduction on re-hopitalizations. If education is mandatory for all the heart failure patients, in implanted patients, specific knowledge and behavior modifications were also implemented. Optimization of the treatments needs to take on account the patient profile. Psychological consequences (particularly for implanted cardiac defibrillators) should be managed and possibilities to return to a normal of possible life (including return to work) evaluated.Accordingly, management of implanted heart failure patients requires a specific skills and cardiologic supervision adapted to the patient situation

Towards a framework for detecting advanced Web bots

Automated programs (bots) are responsible for a large percentage of website traffic. These bots can either be used for benign purposes, such as Web indexing, Website monitoring (validation of hyperlinks and HTML code), feed fetching Web content and data extraction for commercial use or for malicious ones, including, but not limited to, content scraping, vulnerability scanning, account takeover, distributed denial of service attacks, marketing fraud, carding and spam. To ensure their security, Web servers try to identify bot sessions and apply special rules to them, such as throttling their requests or delivering different content. The methods currently used for the identification of bots are based either purely on rule-based bot detection techniques or a combination of rulebased and machine learning techniques. While current research has developed highly adequate methods for Web bot detection, these methods’ adequacy when faced with Web bots that try to remain undetected hasn’t been studied. For this reason, we created and evaluated a Web bot detection framework on its ability to detect conspicuous bots separately from its ability to detect advanced Web bots. We assessed the proposed framework performance using real HTTP traffic from a public Web server. Our experimental results show that the proposed framework has significant ability to detect Web bots that do not try to hide their bot identity using HTTP Web logs (balanced accuracy in a false-positive intolerant server > 95%). However, detecting advanced Web bots that present a browser fingerprint and may present a humanlike behaviour as well is considerably more difficult

Detection of advanced web bots by combining web logs with mouse behavioural biometrics

Web bots vary in sophistication based on their purpose, ranging from simple automated scripts to advanced web bots that have a browser fingerprint, support the main browser functionalities, and exhibit a humanlike behaviour. Advanced web bots are especially appealing to malicious web bot creators, due to their browserlike fingerprint and humanlike behaviour that reduce their detectability. This work proposes a web bot detection framework that comprises two detection modules: (i) a detection module that utilises web logs, and (ii) a detection module that leverages mouse movements. The framework combines the results of each module in a novel way to capture the different temporal characteristics of the web logs and the mouse movements, as well as the spatial characteristics of the mouse movements. We assess its effectiveness on web bots of two levels of evasiveness: (a) moderate web bots that have a browser fingerprint and (b) advanced web bots that have a browser fingerprint and also exhibit a humanlike behaviour. We show that combining web logs with visitors’ mouse movements is more effective and robust toward detecting advanced web bots that try to evade detection, as opposed to using only one of those approaches

Web bot detection evasion using generative adversarial networks

Web bots are programs that can be used to browse the web and perform automated actions. These actions can be benign, such as web indexing and website monitoring, or malicious, such as unauthorised content scraping and scalping. To detect bots, web servers consider bots' fingerprint and behaviour, with research showing that techniques that examine the visitor's mouse movements can be very effective. In this work, we showcase that web bots can leverage the latest advances in machine learning to evade detection based on their mouse movements and touchscreen trajectories (for the case of mobile web bots). More specifically, the proposed web bots utilise Generative Adversarial Networks (GANs) to generate images of trajectories similar to those of humans, which can then be used by bots to evade detection. We show that, even if the web server is aware of the attack method, web bots can generate behaviours that can evade detection

Changes and prognostic value of cardiopulmonary exercise testing parameters in elderly patients undergoing cardiac rehabilitation: The EU-CaRE observational study

Objective We aimed 1) to test the applicability of the previously suggested prognostic value of CPET to elderly cardiac rehabilitation patients and 2) to explore the underlying mechanism of the greater improvement in exercise capacity (peak oxygen consumption, VO2) after CR in surgical compared to non-surgical cardiac patients. Methods Elderly patients (?65 years) commencing CR after coronary artery bypass grafting, surgical valve replacement (surgery-group), percutaneous coronary intervention, percutaneous valve replacement or without revascularisation (non-surgery group) were included in the prospective multi-center EU-CaRE study. CPETs were performed at start of CR, end of CR and 1-year-follow-up. Logistic models and receiver operating characteristics were used to determine prognostic values of CPET parameters for major adverse cardiac events (MACE). Linear models were performed for change in peak VO2 (start to follow-up) and parameters accounting for the difference between surgery and non-surgery patients were sought. Results 1421 out of 1633 EU-CaRE patients performed a valid CPET at start of CR (age 73±5.4, 81% male). No CPET parameter further improved the receiver operation characteristics significantly beyond the model with only clinical parameters. The higher improvement in peak VO2 (25% vs. 7%) in the surgical group disappeared when adjusted for changes in peak tidal volume and haemoglobin. Conclusion CPET did not improve the prediction of MACE in elderly CR patients. The higher improvement of exercise capacity in surgery patients was mainly driven by restoration of haemoglobin levels and improvement in respiratory function after sternotomy

Speaker-independent emotion recognition exploiting a psychologically-inspired binary cascade classification schema

In this paper, a psychologically-inspired binary cascade classification schema is proposed for speech emotion recognition. Performance is enhanced because commonly confused pairs of emotions are distinguishable from one another. Extracted features are related to statistics of pitch, formants, and energy contours, as well as spectrum, cepstrum, perceptual and temporal features, autocorrelation, MPEG-7 descriptors, Fujisakis model parameters, voice quality, jitter, and shimmer. Selected features are fed as input to K nearest neighborhood classifier and to support vector machines. Two kernels are tested for the latter: Linear and Gaussian radial basis function. The recently proposed speaker-independent experimental protocol is tested on the Berlin emotional speech database for each gender separately. The best emotion recognition accuracy, achieved by support vector machines with linear kernel, equals 87.7%, outperforming state-of-the-art approaches. Statistical analysis is first carried out with respect to the classifiers error rates and then to evaluate the information expressed by the classifiers confusion matrices. © Springer Science+Business Media, LLC 2011

Secondary prevention through comprehensive cardiovascular rehabilitation : from knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology

©The European Society of Cardiology 2020. Article reuse guidelines : sagepub.com/journals-permissionsSecondary prevention through comprehensive cardiac rehabilitation has been recognized as the most cost-effective intervention to ensure favourable outcomes across a wide spectrum of cardiovascular disease, reducing cardiovascular mortality, morbidity and disability, and to increase quality of life. The delivery of a comprehensive and ‘modern’ cardiac rehabilitation programme is mandatory both in the residential and the out-patient setting to ensure expected outcomes. The present position paper aims to update the practical recommendations on the core components and goals of cardiac rehabilitation intervention in different cardiovascular conditions, in order to assist the whole cardiac rehabilitation staff in the design and development of the programmes, and to support healthcare providers, insurers, policy makers and patients in the recognition of the positive nature of cardiac rehabilitation. Starting from the previous position paper published in 2010, this updated document maintains a disease-oriented approach, presenting both well-established and more controversial aspects. Particularly for implementation of the exercise programme, advances in different training modalities were added and new challenging populations were considered. A general table applicable to all cardiovascular conditions and specific tables for each clinical condition have been created for routine practice.info:eu-repo/semantics/publishedVersio