MARGOT: Dynamic IoT Resource Discovery for HADR Environments

Smart City services leverage sophisticated IT architectures whose assets are deployed in dynamic and heterogeneous computing and communication scenarios. Those services are particularly interesting for Humanitarian Assistance and Disaster Relief (HADR) operations in urban environments, which could improve Situation Awareness by exploiting the Smart City IT infrastructure. To this end, an enabling requirement is the discovery of the available Internet-of-Things (IoT) resources, including sensors, actuators, services, and computing resources, based on a variety of criteria, such as geographical location, proximity, type of device, type of capability, coverage, resource availability, and communication topology / quality of network links. To date, no single standard has emerged that has been widely adopted to solve the discovery challenge. Instead, a variety of different standards have been proposed and cities have either adopted one that is convenient or reinvented a new standard just for themselves. Therefore, enabling discovery across different standards and administrative domains is a fundamental requirement to enable HADR operations in Smart Cities. To address these challenges, we developed MARGOT (Multi-domain Asynchronous Gateway Of Things), a comprehensive solution for resource discovery in Smart City environments that implements a distributed and federated architecture and supports a wide range of discovery protocols

Long term risk for hypertension, renal impairment, and cardiovascular disease after gastroenteritis from drinking water contaminated with Escherichia coli O157:H7: a prospective cohort study

Objectives To evaluate the risk for hypertension, renal impairment, and cardiovascular disease within eight years of gastroenteritis from drinking water contaminated with Escherichia coli O157:H7 and Campylobacter

Risk of pregnancy-related hypertension within 5 years of exposure to drinking water contaminated with Escherichia coli O157:H7

The authors evaluated the risk for pregnancy-related hypertension among previously healthy women who conceived within 5 years of exposure to drinking water contaminated with Escherichia coli O157.H7 in Walkerton, Canada (2000). Chronic hypertension was defined as systolic/diastolic blood pressure ≥140/90 mm Hg before 20 weeks gestation; gestational hypertension was defined as new onset systolic/diastolic blood pressure ≥140/90 mm Hg ≥20 weeks gestation. The incidence of hypertension was compared between women who were asymptomatic during the outbreak to those who experienced acute gastroenteritis. Blood pressure data were available for 135 of 148 eligible pregnancies. The adjusted relative risks for chronic and gestational hypertension were 1.5 (95% confidence interval [CI]: 0.3-7.7) and 1.0 (95% CI: 0.4-2.5), respectively. Mean arterial pressure before 20 weeks gestation was 2.7 mm Hg higher in women who had acute gastroenteritis (95% CI: 0.05-5.4). A trend toward higher chronic hypertension and mean arterial pressure in early pregnancy was observed among women who experienced gastroenteritis after exposure to bacterially-contaminated drinking water. © 2010 Wiley Periodicals, Inc

Heart failure in chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies conference

The incidence and prevalence of heart failure (HF) and chronic kidney disease (CKD) are increasing, and as such a better understanding of the interface between both conditions is imperative for developing optimal strategies for their detection, prevention, diagnosis, and management. To this end, Kidney Disease: Improving Global Outcomes (KDIGO) convened an international, multidisciplinary Controversies Conference titled Heart Failure in CKD. Breakout group discussions included (i) HF with preserved ejection fraction (HFpEF) and nondialysis CKD, (ii) HF with reduced ejection fraction (HFrEF) and nondialysis CKD, (iii) HFpEF and dialysis-dependent CKD, (iv) HFrEF and dialysis-dependent CKD, and (v) HF in kidney transplant patients. The questions that formed the basis of discussions are available on the KDIGO website http://kdigo.org/conferences/heart-failure-in-ckd/, and the deliberations from the conference are summarized here

Psychosocial impact of undergoing prostate cancer screening for men with BRCA1 or BRCA2 mutations.

OBJECTIVES: To report the baseline results of a longitudinal psychosocial study that forms part of the IMPACT study, a multi-national investigation of targeted prostate cancer (PCa) screening among men with a known pathogenic germline mutation in the BRCA1 or BRCA2 genes. PARTICPANTS AND METHODS: Men enrolled in the IMPACT study were invited to complete a questionnaire at collaborating sites prior to each annual screening visit. The questionnaire included sociodemographic characteristics and the following measures: the Hospital Anxiety and Depression Scale (HADS), Impact of Event Scale (IES), 36-item short-form health survey (SF-36), Memorial Anxiety Scale for Prostate Cancer, Cancer Worry Scale-Revised, risk perception and knowledge. The results of the baseline questionnaire are presented. RESULTS: A total of 432 men completed questionnaires: 98 and 160 had mutations in BRCA1 and BRCA2 genes, respectively, and 174 were controls (familial mutation negative). Participants' perception of PCa risk was influenced by genetic status. Knowledge levels were high and unrelated to genetic status. Mean scores for the HADS and SF-36 were within reported general population norms and mean IES scores were within normal range. IES mean intrusion and avoidance scores were significantly higher in BRCA1/BRCA2 carriers than in controls and were higher in men with increased PCa risk perception. At the multivariate level, risk perception contributed more significantly to variance in IES scores than genetic status. CONCLUSION: This is the first study to report the psychosocial profile of men with BRCA1/BRCA2 mutations undergoing PCa screening. No clinically concerning levels of general or cancer-specific distress or poor quality of life were detected in the cohort as a whole. A small subset of participants reported higher levels of distress, suggesting the need for healthcare professionals offering PCa screening to identify these risk factors and offer additional information and support to men seeking PCa screening

Further delineation of Malan syndrome

Malan syndrome is an overgrowth disorder described in a limited number of individuals. We aim to delineate the entity by studying a large group of affected individuals. We gathered data on 45 affected individuals with a molecularly confirmed diagnosis through an international collaboration and compared data to the 35 previously reported individuals. Results indicate that height is > 2 SDS in infancy and childhood but in only half of affected adults. Cardinal facial characteristics include long, triangular face, macrocephaly, prominent forehead, everted lower lip, and prominent chin. Intellectual disability is universally present, behaviorally anxiety is characteristic. Malan syndrome is caused by deletions or point mutations of NFIX clustered mostly in exon 2. There is no genotype-phenotype correlation except for an increased risk for epilepsy with 19p13.2 microdeletions. Variants arose de novo, except in one family in which mother was mosaic. Variants causing Malan and Marshall-Smith syndrome can be discerned by differences in the site of stop codon formation. We conclude that Malan syndrome has a well recognizable phenotype that usually can be discerned easily from Marshall–Smith syndrome but rarely there is some overlap. Differentiation from Sotos and Weaver syndrome can be made by clinical evaluation only

A proxy gateway solution to provide QoS in tactical networks and disaster recovery scenarios

Many important public services, such as security and public health, as well as the modern tactical military scenarios, rely on Service-oriented Architectures (SoAs) and commercial off-the-shelf (COTS) components to enable the quick development and deployment of distributed services to respond quickly, reduce costs, and ease system integration. However, SoAs make use of verbose networking technologies and require reliable and relatively high bandwidth communications. Tactical scenarios normally cannot rely on such infrastructure and events like natural disasters can severely damage the network infrastructure in rural and urban environments. Thus, there is a need to develop solutions that provide SoA-based application and services running on heterogeneous and often constrained devices that compose tactical and mobile ad-hoc networks with Quality of Service (QoS) levels that meet their requirements. This paper presents the QoS-enabling features and the gateway operational mode (GM) of ACM NetProxy, the network proxy component of a communications middleware specifically developed to support applications in challenged networks. GM allows nodes in an ad-hoc wireless network to be quickly organized and to shape outbound communications to reduce bandwidth consumption and provide QoS. Experimental results obtained during a test in a field demonstration event show its efficiency

Transition From Pediatric to Adult Nephrology Care: Program Report of a Single-Center Experience

Purpose of program: Adolescents and young adults with chronic disease face many personal and systemic barriers that may impede their successful transition from pediatric to adult care, putting them at risk for treatment nonadherence, loss to follow-up, and poor health outcomes. Such barriers include impaired socioemotional functioning, overreliance on adult caregivers, lack of disease-specific knowledge, and poor coordination between pediatric and adult health care services. In 2007, we established a specialized youth to adult nephrology transition clinic at a tertiary care center to address these barriers and provide adolescents and young adults with renal disease followed at the affiliated children’s hospital with a seamless transition to adult care. Sources of information: The attending clinic nephrologist collected data prospectively for this quality improvement report. Methods: The features of this specialized clinic included (1) single point of entry and single triage adult nephrologist, (2) ongoing follow-up with a single adult nephrologist who communicated with the pediatric nephrologists, and (3) a single specialized clinic nurse who provided disease-specific education and helped to ensure ongoing patient engagement and follow-up. Importantly, the transition patients were booked into regular appointment slots in the adult nephrologist’s general clinic, which facilitated regular follow-up without additional resources. The salary of the transition clinic nurse was covered by an unrestricted grant. Patient visits were in-person, except between 2020 and 2021 when visits were by telephone due to the pandemic. Key findings: A total of 213 patients were referred and assessed in the transition clinic from February 2007 until October 2022. Most referrals were from pediatric nephrologists. Among the patients, 29% had a hereditary kidney disease; in 71%, the disease was acquired. The most common disease was glomerulonephritis and ~30% of the patients suffered from a “rare” disease. Of the 213 patients, 123 (58%) continue to be followed up (mean follow-up: 4.8 years), 27 (13%) were transferred to other physicians, in part to accommodate treatment closer to patients’ homes, and 29 (14%) without ongoing care needs were discharged. Only 33 (15%) were lost to follow-up. There were several advantages to the clinic, including the maintenance of accurate records, a process to minimize loss to follow-up, and a “critical mass” of patients with rare diseases, which facilitated development of special expertise in rare disease pathogenesis, diagnosis, treatment, and management of complications. Patients with glomerulonephritis demonstrated a stable serum creatinine over 3 to 15 years, and morbidity (as reflected by emergency room visits and hospitalizations) was low. Limitations: Due to the relatively small numbers of patients in the disease categories, it was not possible to determine conclusively whether attendance of patients in the transition clinic reduced the rate of progression of kidney disease or morbidity. Implications: A dedicated referral, triage, and follow-up process post-transition with only modest financial resources and personnel can result in accurate tracking of clinic data, as well as consistent and reliable follow-up and expert patient care

Secure Multi-Domain Information Sharing in Tactical Networks

Tactical Networks (TNs) are challenging communication environments at the base of modern network-centric warfare, characterized by limited resources, frequent link disruption, and partitioning. TNs typically involve a multitude of units belonging to different domains that need to share information securely over shared and constrained links to enable cooperation. Federation Services offer a model for policy-based information sharing between multiple domains, which permit individual forces and organizations to match mission requirements by allowing a fine-grained selection of the data to exchange. However, while the Federation model alone is not enough to ensure confidentiality and integrity of data transmissions over shared network resources, traditional end-to-end cryptography solutions might not suit low-resources, bandwidth-constrained networking environments. This paper discusses two solutions to enable secure and efficient information sharing in multidomain TNs using Federation Services. The first solution enables the definition of multiple groups of authenticated federates and provides information access control to information senders by leveraging on Attribute-Based Encryption techniques to encrypt federated messages and define, on a per-message basis, a subset of groups that can access the data. The second solution enhances the first one by addressing link disruption and network partitioning in TNs by introducing a distributed group key management service (GkMS) architecture

Exploring value-of-information-based approaches to support effective communications in tactical networks

Tactical networking environments present many challenges in terms of bandwidth, latency, reliability, stability, and connectivity. Sensors can today generate very large data sets that exceed the ability of tactical networks to transfer and disseminate them in a timely manner. Furthermore, the desire to cover larger areas with persistent sensing capabilities, have resulted in the widescale deployment of inexpensive sensors, further widening the gap between the volume of information that is generated and the subset that can successfully be delivered to consumers. This article explores the notion of determining the value of information in order to prioritize and filter information that is disseminated over these tactical networks, focusing on the dissemination of information to and from dismounted soldiers in a battlefield environment. This is a promising approach to mitigate the constraints of tactical networks and to reduce information overload on soldiers