A Multi-Agent Architecture for the Design of Hierarchical Interval Type-2 Beta Fuzzy System

This paper presents a new methodology for building and evolving hierarchical fuzzy systems. For the system design, a tree-based encoding method is adopted to hierarchically link low dimensional fuzzy systems. Such tree structural representation has by nature a flexible design offering more adjustable and modifiable structures. The proposed hierarchical structure employs a type-2 beta fuzzy system to cope with the faced uncertainties, and the resulting system is called the Hierarchical Interval Type-2 Beta Fuzzy System (HT2BFS). For the system optimization, two main tasks of structure learning and parameter tuning are applied. The structure learning phase aims to evolve and learn the structures of a population of HT2BFS in a multiobjective context taking into account the optimization of both the accuracy and the interpretability metrics. The parameter tuning phase is applied to refine and adjust the parameters of the system. To accomplish these two tasks in the most optimal and faster way, we further employ a multi-agent architecture to provide both a distributed and a cooperative management of the optimization tasks. Agents are divided into two different types based on their functions: a structure agent and a parameter agent. The main function of the structure agent is to perform a multi-objective evolutionary structure learning step by means of the Multi-Objective Immune Programming algorithm (MOIP). The parameter agents have the function of managing different hierarchical structures simultaneously to refine their parameters by means of the Hybrid Harmony Search algorithm (HHS). In this architecture, agents use cooperation and communication concepts to create high-performance HT2BFSs. The performance of the proposed system is evaluated by several comparisons with various state of art approaches on noise-free and noisy time series prediction data sets and regression problems. The results clearly demonstrate a great improvement in the accuracy rate, the convergence speed and the number of used rules as compared with other existing approaches

A pseudo feedback-based annotated TF-IDF technique for dynamic crypto-ransomware pre-encryption boundary delineation and features extraction

The cryptography employed against user files makes the effect of crypto-ransomware attacks irreversible even after detection and removal. Thus, detecting such attacks early, i.e. during pre-encryption phase before the encryption takes place is necessary. Existing crypto-ransomware early detection solutions use a fixed time-based thresholding approach to determine the pre-encryption phase boundaries. However, the fixed time thresholding approach implies that all samples start the encryption at the same time. Such assumption does not necessarily hold for all samples as the time for the main sabotage to start varies among different crypto-ransomware families due to the obfuscation techniques employed by the malware to change its attack strategies and evade detection, which generates different attack behaviors. Additionally, the lack of sufficient data at the early phases of the attack adversely affects the ability of feature extraction techniques in early detection models to perceive the characteristics of the attacks, which, consequently, decreases the detection accuracy. Therefore, this paper proposes a Dynamic Pre-encryption Boundary Delineation and Feature Extraction (DPBD-FE) scheme that determines the boundary of the pre-encryption phase, from which the features are extracted and selected more accurately. Unlike the fixed thresholding employed by the extant works, DPBD-FE tracks the pre-encryption phase for each instance individually based on the first occurrence of any cryptography-related APIs. Then, an annotated Term Frequency-Inverse Document Frequency (aTF-IDF) technique was utilized to extract the features from runtime data generated during the pre-encryption phase of crypto-ransomware attacks. The aTF-IDF overcomes the challenge of insufficient attack patterns during the early phases of the attack lifecycle. The experimental evaluation shows that DPBD-FE was able to determine the pre-encryption boundaries and extract the features related to this phase more accurately compared to related works

Immunotoxicity of polystyrene nanoplastics in different hemocyte subpopulations of Mytilus galloprovincialis

Plastic represents 60-80% of litter in the ocean. Degradation of plastic to small fragments leads to the formation of microplastics (MPs <5mm) and nanoplastics (NPs <1 mu m). One of the most widely used and representative plastics found in the ocean is polystyrene (PS). Among marine organisms, the immune system of bivalves is recognized as suitable to assess nanomaterial toxicity. Hemocyte subpopulations [R1 (large granular cells), R2 (small semi-granular cells) and R3 (small agranular or hyaline cells)] of Mytilus galloprovincialis are specialized in particular tasks and functions. The authors propose to examine the effects of different sizes (50 nm, 100 nm and 1 mu m) PS NPs on the different immune cells of mussels when they were exposed to (1 and 10mg.L-1) of PS NPs. The most noteworthy results found in this work are: (i) 1 mu m PS NPs provoked higher immunological responses with respect to 50 and 100nm PS NPs, possibly related to the higher stability in size and shape in hemolymph serum, (ii) the R1 subpopulation was the most affected with respect to R2 and R3 concerning immunological responses and (iii) an increase in the release of toxic radicals, apoptotic signals, tracking of lysosomes and a decrease in phagocytic activity was found in R1

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Value of risk scores in the decision to palliate patients with ruptured abdominal aortic aneurysm

Background: The aim of this study was to develop a 48-h mortality risk score, which included morphology data, for patients with ruptured abdominal aortic aneurysm presenting to an emergency department, and to assess its predictive accuracy and clinical effectiveness in triaging patients to immediate aneurysm repair, transfer or palliative care. Methods: Data from patients in the IMPROVE (Immediate Management of the Patient With Ruptured Aneurysm: Open Versus Endovascular Repair) randomized trial were used to develop the risk score. Variables considered included age, sex, haemodynamic markers and aortic morphology. Backwards selection was used to identify relevant predictors. Predictive performance was assessed using calibration plots and the C-statistic. Validation of the newly developed and other previously published scores was conducted in four external populations. The net benefit of treating patients based on a risk threshold compared with treating none was quantified. Results: Data from 536 patients in the IMPROVE trial were included. The final variables retained were age, sex, haemoglobin level, serum creatinine level, systolic BP, aortic neck length and angle, and acute myocardial ischaemia. The discrimination of the score for 48-h mortality in the IMPROVE data was reasonable (C-statistic 0·710, 95 per cent c.i. 0·659 to 0·760), but varied in external populations (from 0·652 to 0·761). The new score outperformed other published risk scores in some, but not all, populations. An 8 (95 per cent c.i. 5 to 11) per cent improvement in the C-statistic was estimated compared with using age alone. Conclusion: The assessed risk scores did not have sufficient accuracy to enable potentially life-saving decisions to be made regarding intervention. Focus should therefore shift to offering repair to more patients and reducing non-intervention rates, while respecting the wishes of the patient and family

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone