On human-in-the-loop CPS in healthcare: a cloud-enabled mobility assistance service

Despite recent advancements on cloud-enabled and human-in-the-loop cyber-physical systems, there is still a lack of understanding of how infrastructure-related quality of service (QoS) issues affect user-perceived quality of experience (QoE). This work presents a pilot experiment over a cloud-enabled mobility assistive device providing a guidance service and investigates the relationship between QoS and QoE in such a system. In our pilot experiment, we employed the CloudWalker, a system linking smart walkers and cloud platforms, to physically interact with users. Different QoS conditions were emulated to represent an architecture in which control algorithms are performed remotely. Results point out that users report satisfactory interaction with the system even under unfavorable QoS conditions. We also found statistically significant data linking QoE degradation to poor QoS conditions. We finalize discussing the interplay between QoS requirements, the human-in-the-loop effect, and the perceived QoE in healthcare applications

Optimizing C-RAN Backhaul Topologies: A Resilience-Oriented Approach Using Graph Invariants

ABSTRACT: At the verge of the launch of the first commercial fifth generation (5G) system, trends in wireless and optical networks are proceeding toward increasingly dense deployments, supporting resilient interconnection for applications that carry higher and higher capacity and tighter latency requirements. These developments put increasing pressure on network backhaul and drive the need for a re-examination of traditional backhaul topologies. Challenges of impending networks cannot be tackled by star and ring approaches due to their lack of intrinsic survivability and resilience properties, respectively. In support of this re-examination, we propose a backhaul topology design method that formulates the topology optimization as a graph optimization problem by capturing both the objective and constraints of optimization in graph invariants. Our graph theoretic approach leverages well studied mathematical techniques to provide a more systematic alternative to traditional approaches to backhaul design. Specifically, herein, we optimize over some known graph invariants, such as maximum node degree, topology diameter, average distance, and edge betweenness, as well as over a new invariant called node Wiener impact, to achieve baseline backhaul topologies that match the needs for resilient future wireless and optical networks

‘To prevent this disease, we have to stay at home, but if we stay at home, we die of hunger’ – livelihoods, vulnerability and coping with Covid-19 in rural Mozambique

Non-pharmaceutical interventions (NPIs) such as social distancing and travel restrictions have been introduced to prevent the spread of the novel coronavirus (hereinafter Covid). In many countries of the Global South, NPIs are affecting rural livelihoods, but in-depth empirical data on these impacts are limited. We traced the differentiated impacts of Covid NPIs throughout the start of the pandemic May to July 2020. We conducted qualitative weekly phone interviews (n=441) with 92 panelists from nine contrasting rural communities across Mozambique (3 to 7 study weeks), exploring how panelists’ livelihoods changed and how the NPIs intersected with, and often exacerbated, existing vulnerabilities, and created new exposures. The NPIs significantly re-shaped many livelihoods and placed greatest burdens on those with precarious incomes, women, children and the elderly, exacerbating existing vulnerabilities and creating new exposures. Travel and trading restrictions and rising prices for consumables including food meant some respondents were concerned about dying not of Covid, but of hunger because of the disruptions caused by NPIs. No direct health impacts of the pandemic were reported during our study period. Most market-orientated income diversification strategies largely failed to provide resilience to the NPI shocks. The exception was one specific case linked to a socially-minded value chain for baobab, where a strong duty of care helped avoid the collapse of incomes seen elsewhere. In contrast, agricultural and charcoal value chains either collapsed or saw producer prices and volumes reduced. The hyper-covariate, unprecedented nature of the shock caused significant restrictions on livelihoods through trading and transport limits and thus a region-wide decline in cash generation opportunities, which was seen as being unlike any prior shock. The scale of human-made interventions and their repercussions thus raises questions about the roles of institutional actors, diversification and socially-minded trading partners in addressing coping and vulnerability both conceptually and in policy-making

Correlations of mutations in katG, oxyR-ahpC and inhA genes and in vitro susceptibility in Mycobacterium tuberculosis clinical strains segregated by spoligotype families from tuberculosis prevalent countries in South America

Background Mutations associated with resistance to rifampin or streptomycin have been reported for W/Beijing and Latin American Mediterranean (LAM) strain families of Mycobacterium tuberculosis. A few studies with limited sample sizes have separately evaluated mutations in katG, ahpC and inhA genes that are associated with isoniazid (INH) resistance. Increasing prevalence of INH resistance, especially in high tuberculosis (TB) prevalent countries is worsening the burden of TB control programs, since similar transmission rates are noted for INH susceptible and resistant M. tuberculosis strains. Results We, therefore, conducted a comprehensive evaluation of INH resistant M. tuberculosis strains (n = 224) from three South American countries with high burden of drug resistant TB to characterize mutations in katG, ahpC and inhA gene loci and correlate with minimal inhibitory concentrations (MIC) levels and spoligotype strain family. Mutations in katG were observed in 181 (80.8%) of the isolates of which 178 (98.3%) was contributed by the katG S315T mutation. Additional mutations seen included oxyR-ahpC; inhA regulatory region and inhA structural gene. The S315T katG mutation was significantly more likely to be associated with MIC for INH ≥2 μg/mL. The S315T katG mutation was also more frequent in Haarlem family strains than LAM (n = 81) and T strain families. Conclusion Our data suggests that genetic screening for the S315T katG mutation may provide rapid information for anti-TB regimen selection, epidemiological monitoring of INH resistance and, possibly, to track transmission of INH resistant strains.Fil: Dalla Costa, Elis R. State Foundation for Production and Research in Health (FEPPS); Brasil.Fil: Ribeiro, Marta O. State Foundation for Production and Research in Health (FEPPS); Brasil.Fil: Silva, Márcia S. N. State Foundation for Production and Research in Health (FEPPS); Brasil.Fil: Arnold, Liane S. State Foundation for Production and Research in Health (FEPPS); Brasil.Fil: Rostirolla, Diana C. State Foundation for Production and Research in Health (FEPPS); Brasil.Fil: Cafrune, Patricia I. State Foundation for Production and Research in Health (FEPPS); Brasil.Fil: Espinoza, Roger C. Blufstein Clinic Laboratory; Perú.Fil: Palaci, Moises. Federal University of Espírito Santo; Brasil.Fil: Telles, Maria A. Adolfo Lutz Institute; Brasil.Fil: Ritacco, Viviana. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Servicio de Micobacterias; Argentina.Fil: Suffys, Philip N. Oswaldo Cruz Institute; Brasil.Fil: Lopes, Maria L. Evandro Chagas Institute; Brasil.Fil: Campelo, Creuza L. LACEN Ceará; BrasilFil: Miranda, Silvana S. Federal University of Minas Gerais; Brasil.Fil: Kremer, Kristin. National Institute for Public Healthand the Environment (RIVM). Mycobacteria Reference Unit (CIb-LIS); Países Bajos.Fil: Almeida da Silva, Pedro E. Federal Foundation of Rio Grande; Brasil.Fil: de Souza Fonseca, Leila. Federal University of Rio de Janeiro. Tuberculosis Academic Program; Brasil.Fil: Ho, John L. Cornell University; Estados Unidos.Fil: Kritski, Afrânio L. Federal University of Rio de Janeiro. Tuberculosis Academic Program; Brasil.Fil: Rossetti, María L. R. State Foundation for Production and Research in Health (FEPPS); Brasil

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease