Sex- and age-related differences in the management and outcomes of chronic heart failure: an analysis of patients from the ESC HFA EORP Heart Failure Long-Term Registry

Aims: This study aimed to assess age- and sex-related differences in management and 1-year risk for all-cause mortality and hospitalization in chronic heart failure (HF) patients. Methods and results: Of 16 354 patients included in the European Society of Cardiology Heart Failure Long-Term Registry, 9428 chronic HF patients were analysed [median age: 66 years; 28.5% women; mean left ventricular ejection fraction (LVEF) 37%]. Rates of use of guideline-directed medical therapy (GDMT) were high (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers and mineralocorticoid receptor antagonists: 85.7%, 88.7% and 58.8%, respectively). Crude GDMT utilization rates were lower in women than in men (all differences: P\ua0 64 0.001), and GDMT use became lower with ageing in both sexes, at baseline and at 1-year follow-up. Sex was not an independent predictor of GDMT prescription; however, age >75 years was a significant predictor of GDMT underutilization. Rates of all-cause mortality were lower in women than in men (7.1% vs. 8.7%; P\ua0=\ua00.015), as were rates of all-cause hospitalization (21.9% vs. 27.3%; P\ua075 years. Conclusions: There was a decline in GDMT use with advanced age in both sexes. Sex was not an independent predictor of GDMT or adverse outcomes. However, age >75 years independently predicted lower GDMT use and higher all-cause mortality in patients with LVEF 6445%

A blockchain-based Trust System for the Internet of Things

Comunicació presentada a la SACMAT '18: The 23rd ACM Symposium on Access Control Models and Technologies, celebrada a Indianapolis (Estats Units d'Amèrica) del 13 al 15 de juny de 2018.One of the biggest challenges for the Internet of Things (IoT) is to bridge the currently fragmented trust domains. The traditional PKI model relies on a common root of trust and does not fit well with the heterogeneous IoT ecosystem where constrained devices belong to independent administrative domains. In this work we describe a distributed trust model for the IoT that leverages the existing trust domains and bridges them to create end-to-end trust between IoT devices without relying on any common root of trust. Furthermore we define a new cryptographic primitive, denoted as obligation chain designed as a credit-based Blockchain with a built-in reputation mechanism. Its innovative design enables a wide range of use cases and business models that are simply not possible with current Blockchain-based solutions while not experiencing traditional blockchain delays. We provide a security analysis for both the obligation chain and the overall architecture and provide experimental tests that show its viability and quality

Analysing wireless EEG based functional connectivity measures with respect to change in environmental factors

In this paper we present a systematic exploration to formulate a predictive model of the human cognitive process with the changing environmental conditions at workplace. We select six different environmental conditions with small change in temperature/ventilation representative of realistic work environment having manual control. EEG data were acquired through 19-channel wireless system from three participants and CO2, Temperature, Relative humidity were recorded throughout the six conditions. The EEG data was pre-processed using an artifact reduction algorithm and 129 neurophysiological features were extracted from functional connectivity measures using complex network analysis. The environmental data were processed to generate 15 time/frequency domain features. Five best features selected through a ranking algorithm for all the variables across the six conditions were processed to formulate a model (environmental parameters as predictors) using retrospective 10-fold cross-validation in conjunction with multiple linear regression. The model was prospectively evaluated over 10 runs on a test set to predict the EEG variable across the six conditions and parameters corresponding to the run producing least root mean square error were reported. Our exploration shows that the condition having no modulation of the ambient environmental parameters reflects the optimum condition for predicting the EEG features using the examined environmental parameters

Role of diuretics, β blockers, and statins in increasing the risk of diabetes in patients with impaired glucose tolerance: reanalysis of data from the NAVIGATOR study.

OBJECTIVE: To examine the degree to which use of β blockers, statins, and diuretics in patients with impaired glucose tolerance and other cardiovascular risk factors is associated with new onset diabetes. DESIGN: Reanalysis of data from the Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) trial. SETTING: NAVIGATOR trial. PARTICIPANTS: Patients who at baseline (enrolment) were treatment naïve to β blockers (n=5640), diuretics (n=6346), statins (n=6146), and calcium channel blockers (n=6294). Use of calcium channel blocker was used as a metabolically neutral control. MAIN OUTCOME MEASURES: Development of new onset diabetes diagnosed by standard plasma glucose level in all participants and confirmed with glucose tolerance testing within 12 weeks after the increased glucose value was recorded. The relation between each treatment and new onset diabetes was evaluated using marginal structural models for causal inference, to account for time dependent confounding in treatment assignment. RESULTS: During the median five years of follow-up, β blockers were started in 915 (16.2%) patients, diuretics in 1316 (20.7%), statins in 1353 (22.0%), and calcium channel blockers in 1171 (18.6%). After adjusting for baseline characteristics and time varying confounders, diuretics and statins were both associated with an increased risk of new onset diabetes (hazard ratio 1.23, 95% confidence interval 1.06 to 1.44, and 1.32, 1.14 to 1.48, respectively), whereas β blockers and calcium channel blockers were not associated with new onset diabetes (1.10, 0.92 to 1.31, and 0.95, 0.79 to 1.13, respectively). CONCLUSIONS: Among people with impaired glucose tolerance and other cardiovascular risk factors and with serial glucose measurements, diuretics and statins were associated with an increased risk of new onset diabetes, whereas the effect of β blockers was non-significant. TRIAL REGISTRATION: ClinicalTrials.gov NCT00097786