RLT Code Based Handshake-Free Reliable MAC Protocol for Underwater Sensor Networks

The characteristics of underwater acoustic channels such as long propagation delay and low bit rate cause the medium access control (MAC) protocols designed for radio channels to either be inapplicable or have low efficiency for underwater sensor networks (UWSNs). Meanwhile, due to high bit error, conventional end-to-end reliable transfer solutions bring about too many retransmissions and are inefficient in UWSN. In this paper, we present a recursive LT (RLT) code. With small degree distribution and recursive encoding, RLT achieves reliable transmission hop-by-hop while reducing the complexity of encoding and decoding in UWSN. We further propose an RLT code based handshake-free (RCHF) reliable MAC protocol. In RCHF protocol, each node maintains a neighbor table including the field of state, and packages are forwarded according to the state of a receiver, which can avoid collisions of sending-receiving and overhearing. The transmission-avoidance time in RCHF decreases data-ACK collision dramatically. Without RTS/CTS handshaking, the RCHF protocol improves channel utilization while achieving reliable transmission. Simulation results show that, compared with the existing reliable data transport approaches for underwater networks, RCHF can improve network throughput while decreasing end-to-end overhead

Development and external validation of a prognostic multivariable model on admission for hospitalized patients with COVID-19

Summary Background COVID-19 pandemic has developed rapidly and the ability to stratify the most vulnerable patients is vital. However, routinely used severity scoring systems are often low on diagnosis, even in non-survivors. Therefore, clinical prediction models for mortality are urgently required. Methods We developed and internally validated a multivariable logistic regression model to predict inpatient mortality in COVID-19 positive patients using data collected retrospectively from Tongji Hospital, Wuhan (299 patients). External validation was conducted using a retrospective cohort from Jinyintan Hospital, Wuhan (145 patients). Nine variables commonly measured in these acute settings were considered for model development, including age, biomarkers and comorbidities. Backwards stepwise selection and bootstrap resampling were used for model development and internal validation. We assessed discrimination via the C statistic, and calibration using calibration-in-the-large, calibration slopes and plots. Findings The final model included age, lymphocyte count, lactate dehydrogenase and SpO 2 as independent predictors of mortality. Discrimination of the model was excellent in both internal (c=0·89) and external (c=0·98) validation. Internal calibration was excellent (calibration slope=1). External validation showed some over-prediction of risk in low-risk individuals and under-prediction of risk in high-risk individuals prior to recalibration. Recalibration of the intercept and slope led to excellent performance of the model in independent data. Interpretation COVID-19 is a new disease and behaves differently from common critical illnesses. This study provides a new prediction model to identify patients with lethal COVID-19. Its practical reliance on commonly available parameters should improve usage of limited healthcare resources and patient survival rate. Funding This study was supported by following funding: Key Research and Development Plan of Jiangsu Province (BE2018743 and BE2019749), National Institute for Health Research (NIHR) (PDF-2018-11-ST2-006), British Heart Foundation (BHF) (PG/16/65/32313) and Liverpool University Hospitals NHS Foundation Trust in UK. Research in context Evidence before this study Since the outbreak of COVID-19, there has been a pressing need for development of a prognostic tool that is easy for clinicians to use. Recently, a Lancet publication showed that in a cohort of 191 patients with COVID-19, age, SOFA score and D-dimer measurements were associated with mortality. No other publication involving prognostic factors or models has been identified to date. Added value of this study In our cohorts of 444 patients from two hospitals, SOFA scores were low in the majority of patients on admission. The relevance of D-dimer could not be verified, as it is not included in routine laboratory tests. In this study, we have established a multivariable clinical prediction model using a development cohort of 299 patients from one hospital. After backwards selection, four variables, including age, lymphocyte count, lactate dehydrogenase and SpO 2 remained in the model to predict mortality. This has been validated internally and externally with a cohort of 145 patients from a different hospital. Discrimination of the model was excellent in both internal (c=0·89) and external (c=0·98) validation. Calibration plots showed excellent agreement between predicted and observed probabilities of mortality after recalibration of the model to account for underlying differences in the risk profile of the datasets. This demonstrated that the model is able to make reliable predictions in patients from different hospitals. In addition, these variables agree with pathological mechanisms and the model is easy to use in all types of clinical settings. Implication of all the available evidence After further external validation in different countries the model will enable better risk stratification and more targeted management of patients with COVID-19. With the nomogram, this model that is based on readily available parameters can help clinicians to stratify COVID-19 patients on diagnosis to use limited healthcare resources effectively and improve patient outcome

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

bike factory 4.0

Discussions about bicycle never stop in Amsterdam. After all these years’ theory as well as practice, it is generally accepted that in such a compact and flat city, bike has been and would remain the best way of mobility in the next few decades. However, according to statistics, though bike has been the best appreciated mode of mobility for Amsterdamers, public transports and cars that are less convenient in the city are still the first choices for visitors of Amsterdam. So in promoting bike as a sustainable and applicable way within the city, there’s still a huge potential in visitors who constitute 1/3 of the whole population, to raise their awareness and finally raise their choices for bike when transferring on the edge of the city

Network Teaching Technology Based on Big Data Mining and Information Fusion

With the continuous development of modern multimedia technology, the integration of computer technology into the teaching of various subjects has become a trend of the times. The application of computer media and network technology in mathematics teaching improves the integration of mathematics teaching and the integration of resources. A mathematics teaching network media fusion technology is proposed based on big data mining and information fusion, which combines the characteristics of multimedia and network technology in opening, creativity, subjectivity, and so on, and the database model of mathematics teaching is constructed. The multithread integrated scheduling method is used to design the mathematics teaching database model, the fuzzy control method is used to control the multimedia in mathematics teaching, and the big data association rule mining method is used to realize the information fusion of mathematics teaching resources. The optimization and integration of mathematics teaching resources and adaptive scheduling are realized under the technology of computer media and network, and the level of mathematics teaching is improved. The test results show that using this method to design the computer network media of mathematics teaching has a better ability of integrating and dispatching mathematics teaching resources, and the integration of mathematics teaching resources is stronger, which promotes the improvement of mathematics teaching level

A Bibliometric Framework for Identifying “Princes” Who Wake up the “Sleeping Beauty” in Challenge-type Scientific Discoveries

Purpose: This paper develops and validates a bibliometric framework for identifying the “princes” (PR) who wake up the “sleeping beauty” (SB) in challenge-type scientific discoveries, so as to figure out the awakening mechanisms, and promote potentially valuable but not readily accepted innovative research. (A PR is a research study.) Design/methodology/approach: We propose that PR candidates must meet the following four criteria: (1) be published near the time when the SB began to attract a lot of citations; (2) be highly cited papers themselves; (3) receive a substantial number of co-citations with the SB; and (4) within the challenge-type discoveries which contradict established theories, the “pulling effect” of the PR on the SB must be strong. We test the usefulness of the bibliometric framework through a case study of a key publication by the 2014 chemistry Nobel laureate Stefan W. Hell, who negated Ernst Abbe's diffraction limit theory, one of the most prominent paradigms in the natural sciences. Findings: The first-ranked candidate PR article identified by the bibliometric framework is in line with historical facts. An SB may need one or more PRs and even “retinues” to be “awakened.” Documents with potential awakening functionality tend to be published in prestigious multidisciplinary journals with higher impact and wider scope than the journals publishing SBs. Research limitations: The above framework is only applicable to transformative innovations, and the conclusions are drawn from the analysis of one typical SB and her awakening process. Therefore the generality of our work might be limited. Practical implications: Publications belonging to so-called transformative research, even when less frequently cited, should be given special attention as early as possible, because they may suddenly attract many citations after a period of sleep, as reflected in our case study. Originality/value: The definition of PR(s) as the first paper(s) that cited the SB article (self-citing excluded) has its limitations. Instead, the SB-PR co-citations should be given priority in current environment of scholarly communication. Since the “premature” or “transformative” breakthroughs in the challenge-type SB documents are either beyond the current knowledge domain, or violate established paradigms, people's psychological distance from the SB is larger than that from the PR, which explains why the annual citations of the PR are usually higher than those of the SB, especially prior to or during the SB's citation boom period