An agent-based evolutionary approach for manufacturing system layout design

Dissertação apresentada na Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa para obtenção do grau de Mestre em Engenharia Electrotécnica e de ComputadoresIn this thesis it is presented an approach to the problem of layout design for a manufacturing system, which is an important part of its design stage, given that it has influence in the system efficiency and, therefore, in its output rate and fault handling capabilities. The presented approach is based on a Genetic Algorithm (GA) that, by using information provided by the the user through an ontology file, and by using algorithms from graph-theory, designs the layout of a manufacturing system. The instances of the ontology represent manufacturing resources and their characteristics that, when they are being used by the algorithm, are encoded in chromosomes and in their genes. The algorithm begins with a number of chromosomes with low fitness which, with the directed evolution provided by the algorithm, that is restricted by the control parameters that might be tunned by the user, improve with the passing of the new generations. It is considered that the fittest solution is the one that connects, in order, all the resources required by the manufacturing plan, described in the ontology, without the occurrence of overlaps when the layout is constructed. The configuration presented by the transport system that handles parts and materials, in the selected layout, is only dependent on the available resources and on the fitness function used by the GA, being that the last cannot be changed by the user. This approach differs from others by positioning simultaneously all the components of the manufacturing system and not only workstations or transport system. The solution is directed to evolvable assembly systems, purpose for which it was implemented inside an agent, so it can be integrated in a Multiagent System (MAS) to be used in the control of a manufacturing system with minimal changes. Keywords: layout design, manufacturing system, multiagent system, ontology, genetic algorithm

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants.

BACKGROUND: Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. METHODS: We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. FINDINGS: The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. INTERPRETATION: Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. FUNDING: WHO

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. Copyright (C) 2021 World Health Organization; licensee Elsevier

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings

A knowledge-based, secure and dependable self-healing architecture for the smart grid

Tese de mestrado, Segurança Informática, Universidade de Lisboa, Faculdade de Ciências, 2016As redes de distribuição de eletricidade são infraestruturas críticas que, em casos de incapacitação ou destruição, provocariam um efeito debilitante na economia e na segurança pública. Estas redes são cada vez mais suportadas por sistemas complexos e redes de comunicações, ganhando desta forma alguma inteligência e autonomia. A informação que estes sistemas geram e as decisões e ações que tomam são limitadas pela informação que têm. Em casos nos quais não tenham, por desenho, toda a informação relevante para o seu contexto de atuação, podem enganar os operadores e tomar ações prejudiciais. A dependência dos sistemas e comunicações levanta também preocupações sobre o desempenho, privacidade, segurança e confiabilidade, que se estendem além de possíveis faltas na rede elétrica. Neste sentido, existem soluções dedicadas ao tratamento automático de faltas na rede elétrica, existindo também soluções dedicadas ao tratamento de faltas nos sistemas e comunicações, fazendo-o separadamente. No entanto, como demonstrado pelos incidentes na Ucrânia, no final de 2015, faltas e falhas em diferentes camadas da rede inteligente podem estar relacionadas. Adicionalmente, embora exista alguma preocupação com a segurança e a confiabilidade das soluções de tratamento automático de faltas na rede elétrica no âmbito de alguns projetos europeus, os projetos piloto focam-se maioritariamente nos aspetos funcionais destas soluções, o que poderá comprometer a segurança de futuras instalações. Em resposta aos problemas acima descritos, nesta tese utiliza-se uma abordagem com base em conhecimento e segurança para desenhar e propor um sistema de tratamento automático de faltas na rede inteligente, que explora as ligações atrás mencionadas. Inicialmente, são definidos requisitos de alto nível para as componentes funcional, segurança e confiabilidade, desempenho, operação e manutenção. Estes requisitos são desagregados em requisitos de baixo nível para os quais ´e proposta uma arquitetura de sistema com módulos funcionais e não funcionais. No caso específico dos requisitos de segurança e confiabilidade, foi realizado um levantamento das ameaças e vulnerabilidades `a componente aplicacional do sistema, com o objetivo de identificar os controlos necessários e propor um conjunto de componentes que, sendo eles próprios conformes, garantem conformidade com os controlos identificados. A análise inicia-se com a identificação dos ativos relevantes, a que se segue a identificação das ameaças e vulnerabilidades correspondentes, com maior foco nas ameaças para a aplicação e na ameaça que esta, se e quando comprometida, pode constituir para a rede inteligente. Dos controlos identificados, são apenas incluídos no desenho aqueles que têm de ser implementados através de componentes aplicacionais ou para os quais a aplicação tem de dar algum tipo de suporte. Os controlos externos não são cobertos por esta investigação. Ainda sobre o desenho funcional, ´e feito um modelo da rede inteligente, incluindo os sistemas e componentes das suas várias camadas, com o objetivo de identificar as configurações que cada um suporta e as ligações entre eles. São também modelados, com o objetivo de identificar ligações e dependências: o processo de operação da rede elétrica, um processo genérico representativo dos processos e serviços dependentes do estado operacional da rede elétrica e o processo de tratamento automático. Estes modelos são utilizados na fase de implementação. A arquitetura resultante é a de um sistema multi-agente com agentes geograficamente distribuídos e replicados, designados por entidades especialistas em tratamento de faltas. Cada entidade é responsável por um domínio de tratamento limitado, correspondendo a um conjunto de sistemas, componentes e serviços da rede inteligente que fazem parte do seu âmbito de supervisão. Raciocina sobre conhecimento assente em factos e regras. Supervisiona o seu domínio, diagnosticando faltas, criando planos de recuperação e reconfigurando a rede inteligente com base nesses planos. Coopera com outras entidades. Aprende com os resultados e consequências da sua atuação. Integra componentes de segurança e confiabilidade para prevenir e tolerar faltas e intrusões nos seus próprios componentes. O sistema é implementado parcialmente para prova do conceito. A implementação inclui a definição de um domínio de tratamento, da ontologia correspondente, do modelo de conhecimento com factos e regras, dos objetivos de tratamento e de um conjunto de queries aplicáveis ao modelo. O domínio de tratamento inclui componentes da rede elétrica, equipamentos de rede, computadores e um sistema de controlo de acessos físicos, cobrindo desta forma diferentes camadas da rede inteligente. Para validação da implementação, os objetivos e queries são submetidos a um motor de inferência, no qual o modelo de conhecimento é previamente carregado, simulando o comportamento de uma réplica nos diferentes estados do processo de tratamento. O processo é repetido para quatro cenários de faltas e falhas de complexidade crescente, incluindo um cenário de falta de conhecimento em que o resultado da inferência, demonstrando a necessidade de manter as bases de conhecimento atualizadas. A implementação dos restantes módulos e integração do módulo de conhecimento é deixada para trabalho futuro, o que limita a validação da segurança da solução. Por definição, os controlos incluídos na arquitetura proposta respondem aos requisitos do sistema, dado que o desenho da solução utiliza módulos de segurança e confiabilidade identificados através de uma análise de ameaças e vulnerabilidades. No entanto, a verificação de que estes controlos são corretamente implementados e a validação da robustez dessa implementação está dependente da implementação dos módulos e, por esta razão, é deixada também para trabalho futuro. Validamos também a robustez do desenho proposto em termos de liveness e safety. Neste sentido, apresentamos uma definição para cada uma destas propriedades no contexto da solução proposta, apresentamos um conjunto de cenários em que as mesmas são comprometidas e justificamos o porquê de esses cenários não serem possíveis. No caso da liveness, o sistema deve executar continuamente desde a sua instalação até ao fim do seu ciclo de vida, entre eventuais interrupções programadas. Para a sua validação focamo-nos nas interações entre os vários módulos, com os sistemas e componentes da rede inteligente e entre entidades. No caso da safety, as ações do sistema devem basear-se apenas em informação atualizada, recolhida dos sistemas e componentes da rede inteligente. Neste caso, o foco é no conteúdo do modelo de conhecimento, na coordenação entre réplicas e a execução de comandos nos sistemas e componentes da rede inteligente. Por último, discutimos um conjunto de tópicos de desenho e implementação que, sendo críticos para a segurança e robustez do sistema proposto, dependem do contexto específico da cada rede inteligente e fornecemos recomendações e orientações para os mesmos. Assumindo a existência de outros sistemas instalados na rede inteligente com atuação possivelmente concorrente com a aqui considerada, é necessário definir qual é o âmbito de cada um esse haverá ou não interação entre o sistema aqui proposto e esses sistemas. O sistema aqui proposto poderá utilizar os sensores, atuadores e redes de comunicações já existentes, dependendo de garantias funcionais, desempenho, capacidade e segurança dados pelos mesmos, para adquirir a informação necessária e controlar os sistemas e componentes da rede inteligente, sendo necessário identificar as necessidades de implementação associadas. A alternativa ´e construir completa ou parcialmente uma infraestrutura dedicada. Este sistema poderá ser criado de raiz ou a partir de outros sistemas já existentes e que contenham módulos com funcionalidades semelhantes às identificadas no desenho da solução. É necessário instalar, operar e manter o sistema com o conhecimento necessário à tomada de decisão. Se tal não for feito, o sistema poderá tomar decisões prejudiciais. A distribuição do sistema, em termos de número de domínios, e a sua replicação, em termos de número de réplicas, tendo previsivelmente um impacto elevado nos custos da solução, deverão ter em conta análises de risco e de custo-benefício. Uma distribuição com granularidade apropriada e um número suficiente de réplicas com distribuição adequada permitem que o sistema funcione corretamente também em casos de partição de comunicações e/ou conectividade. As decisões tomadas, relacionadas com estes tópicos, têm impacto direto no desempenho, segurança e confiabilidade da solução. Para trabalho futuro, a nível de desenho, é proposto: a evolução de alguns módulos já incluídos no desenho da solução e o desenvolvimento de novos módulos, a modelação de mais sistemas, componentes e serviços e a atualização e extensão da análise de ameaças e vulnerabilidades. A nível de implementação, é proposto: a formalização e manutenção¸ de uma ontologia de suporte à descrição dos sistemas, componentes e serviços, a atualização dos factos, com base na ontologia, e a melhoria das regras, aproximando-as incrementalmente da realidade, o desenvolvimento do código de software associado a cada módulo e a extensão das recomendações e orientações apresentadas na discussão para incluírem exemplos práticos.The increasing complexity of the smart grid raises concerns with performance, privacy, security and dependability that go further beyond electrical network faults. In this regard, electrical network self-healing and commercially available security solutions are capable of handling a set of electrical network, systems and communications faults automatically, but separately. However, as shown by the Ukrainian incidents, in 2015, there can be cause-effect connections between faults and failures in different smart grid layers. Additionally, although a set of European projects is addressing the security and dependability of self-healing use cases, the pilot projects focus mainly on functional issues, possibly compromising the security of future roll-outs. We use a knowledge-based and security-by-design approach to design and propose a secure and dependable Self-Healing System (SHS) with awareness of the aforementioned connections. It is a Multi Agent System (MAS) with replicated Self-Healing Expert Entity (SHEE) agents. Each SHEE is responsible for the self-healing process in a limited domain, corresponding to a set of systems, components and processes assigned to its scope of supervision. It reasons with knowledge based on facts and rules. It monitors the domain, diagnoses eventual faults, creates recovery plans and reconfigures the smart grid based on these plans. It cooperates with other SHEEs. It learns from the results and consequences of its actions. It comprises a set of security and dependability features to prevent and tolerate faults and intrusions, resulting from a threat and vulnerability assessment. We perform a partial implementation of our system, consisting in the definition of a self-healing domain, the corresponding ontology, the knowledge model with facts and reasoning rules and a set of goals and queries. We successfully validate the SHS concept as a solution to the described problems. The goals and queries are submitted to a standalone inference engine, which is previously loaded with the knowledge model, simulating the behavior of a SHEE replica through the different states of the self-healing process. The process is repeated for four different complexity increasing fault and failure scenarios. We discuss and provide guidance for a set of design and implementation issues that, being critical to the security and robustness of the SHS, depend on each smart grid specific context

Footprints of a microbial toxin from the gut microbiome to mesencephalic mitochondria

Idiopathic Parkinson's disease (PD) is characterised by alpha-synuclein (aSyn) aggregation and death of dopaminergic neurons in the midbrain. Recent evidence posits that PD may initiate in the gut by microbes or their toxins that promote chronic gut inflammation that will ultimately impact the brain. In this work, we sought to demonstrate that the effects of the microbial toxin β-N-methylamino-L-alanine (BMAA) in the gut may trigger some PD cases, which is especially worrying as this toxin is present in certain foods but not routinely monitored by public health authorities.This work was funded by Santa Casa da Misericórdia de Lisboa, Portugal, through Mantero Belard Neurosciences Prize 2016 (MB-40-2016); by FMUCPEPITA (2018); by the European Regional Development Fund (ERDF), through the Centro 2020 Regional Operational Programme under project CENTRO-01-0145-FEDER-000012 (HealthyAging 2020) and through the COMPETE 2020 - Operational Programme for Competitiveness and Internationalization and by Portuguese national funds via FCT—Fundação para a Ciência e a Tecnologia under projects PTDC/MED-NEU/3644/2020, PINFRA/22184/2016/POCI-01-0145-FEDER-022184 and UIDB/04539/2020. EC was supported by fellowship MB-40-2016. IT was supported by IF/01061/2014 Investigator contract. JDM is supported by PhD fellowship PD/BD/146409/2019, DN-C is supported by PhD fellowship SFRH/B

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p<0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

International audienceBACKGROUND - Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. METHODS - We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. FINDINGS - The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. INTERPRETATION - Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings