Implementing Deep Learning Techniques in 5G IoT Networks for 3D Indoor Positioning: DELTA (DeEp Learning-Based Co-operaTive Architecture).

In the near future, the fifth-generation wireless technology is expected to be rolled out, offering low latency, high bandwidth and multiple antennas deployed in a single access point. This ecosystem will help further enhance various location-based scenarios such as assets tracking in smart factories, precise smart management of hydroponic indoor vertical farms and indoor way-finding in smart hospitals. Such a system will also integrate existing technologies like the Internet of Things (IoT), WiFi and other network infrastructures. In this respect, 5G precise indoor localization using heterogeneous IoT technologies (Zigbee, Raspberry Pi, Arduino, BLE, etc.) is a challenging research area. In this work, an experimental 5G testbed has been designed integrating C-RAN and IoT networks. This testbed is used to improve both vertical and horizontal localization (3D Localization) in a 5G IoT environment. To achieve this, we propose the DEep Learning-based co-operaTive Architecture (DELTA) machine learning model implemented on a 3D multi-layered fingerprint radiomap. The DELTA begins by estimating the 2D location. Then, the output is recursively used to predict the 3D location of a mobile station. This approach is going to benefit use cases such as 3D indoor navigation in multi-floor smart factories or in large complex buildings. Finally, we have observed that the proposed model has outperformed traditional algorithms such as Support Vector Machine (SVM) and K-Nearest Neighbor (KNN).

RSS Indoor Localization Based on a Single Access Point.

This research work investigates how RSS information fusion from a single, multi-antenna access point (AP) can be used to perform device localization in indoor RSS based localization systems. The proposed approach demonstrates that different RSS values can be obtained by carefully modifying each AP antenna orientation and polarization, allowing the generation of unique, low correlation fingerprints, for the area of interest. Each AP antenna can be used to generate a set of fingerprint radiomaps for different antenna orientations and/or polarization. The RSS fingerprints generated from all antennas of the single AP can be then combined to create a multi-layer fingerprint radiomap. In order to select the optimum fingerprint layers in the multilayer radiomap the proposed methodology evaluates the obtained localization accuracy, for each fingerprint radio map combination, for various well-known deterministic and probabilistic algorithms (Weighted k-Nearest-Neighbor-WKNN and Minimum Mean Square Error-MMSE). The optimum candidate multi-layer radiomap is then examined by calculating the correlation level of each fingerprint pair by using the "Tolerance Based-Normal Probability Distribution (TBNPD)" algorithm. Both steps take place during the offline phase, and it is demonstrated that this approach results in selecting the optimum multi-layer fingerprint radiomap combination. The proposed approach can be used to provide localisation services in areas served only by a single AP.

On the Realistic Radio and Network Planning of IoT Sensor Networks.

Planning and deploying a functional large scale Wireless Sensor Network (WSN) or a Network of Internet of Things (IoTs) is a challenging task, especially in complex urban environments. A main network design bottleneck is the existence and/or correct usage of appropriate cross layer simulators that can generate realistic results for the scenario of interest. Existing network simulators tend to overlook the complexity of the physical radio propagation layer and consequently do not realistically simulate the main radio propagation conditions that take place in urban or suburban environments, thus passing inaccurate results between Open Systems Interconnection (OSI) layers. This work demonstrates through simulations and measurements that, by correctly passing physical information to higher layers, the overall simulation process produces more accurate results at the network layer. It is demonstrated that the resulting simulation methodology can be utilized to accomplish realistic wireless planning and performance analysis of the deployed nodes, with results that are very close to those of real test-beds, or actual WSN deployments.

Fusing Bluetooth Beacon Data with Wi-Fi Radiomaps for Improved Indoor Localization.

Indoor user localization and tracking are instrumental to a broad range of services and applications in the Internet of Things (IoT) and particularly in Body Sensor Networks (BSN) and Ambient Assisted Living (AAL) scenarios. Due to the widespread availability of IEEE 802.11, many localization platforms have been proposed, based on the Wi-Fi Received Signal Strength (RSS) indicator, using algorithms such as K-Nearest Neighbour (KNN), Maximum A Posteriori (MAP) and Minimum Mean Square Error (MMSE). In this paper, we introduce a hybrid method that combines the simplicity (and low cost) of Bluetooth Low Energy (BLE) and the popular 802.11 infrastructure, to improve the accuracy of indoor localization platforms. Building on KNN, we propose a new positioning algorithm (dubbed i-KNN) which is able to filter the initial fingerprint dataset (i.e., the radiomap), after considering the proximity of RSS fingerprints with respect to the BLE devices. In this way, i-KNN provides an optimised small subset of possible user locations, based on which it finally estimates the user position. The proposed methodology achieves fast positioning estimation due to the utilization of a fragment of the initial fingerprint dataset, while at the same time improves positioning accuracy by minimizing any calculation errors.

Screening for Distress in the Radiation Therapy Department: Distress Incidence by Sex, Treatment Intent, and Ethnicity.

INTRODUCTION: Health care is moving toward personalized (person-centered) holistic care. Screening for distress is a national initiative that promotes this and will allow for better interdisciplinary collaboration between health care providers. The use of distress screening allows our cancer centers to determine trends and correlations between patient demographics and patient distress. Distress leads to increased physical complications, increased patient anxiety, decreased compliancy with treatment, and an overall negative experience in the health care system. This tool helps health care providers to identify and manage patient distress in a timely manner. METHODS: A screening for distress questionnaire was completed by 119 new patients entering the department of radiation therapy at the Saskatoon Cancer Center, Saskatoon, Saskatchewan, Canada. Results were segregated by sex, treatment intent, and ethnicity and then were subjected to a Wilcoxon rank sum test to determine statistical significance between test groups. RESULTS: Results indicated higher distress levels in female versus male patients, palliative care versus curative intent, and Aboriginal/Métis versus non-Aboriginal/non-Métis populations. The most commonly reported symptoms of distress included recurring fatigue, poor overall well-being, and high levels of anxiety. The fears/worries portion of the distress checklist was most commonly reported. CONCLUSIONS: The screening for distress questionnaire has been proven to be a valuable tool in the facilitation of collaborative health care and holistic patient care. Because of higher than average distress scores, further investigation should be done with Aboriginal/Métis peoples in the health care system.

Hyponatremic renal pseudofailure and massive ascites following normal vaginal delivery: a diagnostic and therapeutic challenge.

We report the fifth, to our knowledge, published case of spontaneous intraperitoneal bladder rupture after normal, vacuum-assisted in this occasion, vaginal delivery of a 29-year-old female patient. Diagnosis was established not by imaging or intraoperative findings, but, rather, by the examination and comparison of patient's blood, urine, and peritoneal fluid urea and creatinine levels, which, due to the patient's delayed referral and sequent development of uroperitoneum and hyponatremic renal pseudofailure, were abnormal and characteristic of her medical condition. The patient was successfully managed conservatively and was discharged the sixth day after admission. Due to the rare nature of such medical condition and based on the relative literature, we propose a diagnostic and management algorithm for such cases.

Pharyngocutaneous fistula complicating laryngectomy: can metronidazole help?

AIM: To evaluate the use of metronidazole as a prophylactic agent against pharyngocutaneous fistula (PCF) formation. PATIENTS AND METHODS: Seventy patients who underwent total laryngectomy between 2000 and 2008 in our department were divided into two groups. The first group (M+ group) was placed on a 10-day metronidazole regimen (2 days prior to surgery and 7 days following). The second group (M- group) received only regular preoperative chemoprophylaxis. RESULTS: In total, 17 (24.3%) incidents of PCF were reported, 3 of which were in the M+ group, with the remainder in the M- group. A statistically significant reduction in the PCF rate was noted in favor of metronidazole in the overall population (p = 0.005), as well as in the patient group that had received radiotherapy prior to surgery (p = 0.03). CONCLUSION: Metronidazole administered for a total of 10 days pre- and postoperatively seems to lower the incidence rate of PCF formation.

Acute febrile neutrophilic dermatosis (Sweet's syndrome) in a child, associated with a rotavirus infection: a case report.

INTRODUCTION: Sweet's syndrome characterized by fever, blood neutrophilia and inflammatory skin lesions, is rarely diagnosed in children. It presents in three clinical settings: classical Sweet's syndrome, usually after a respiratory tract infection; malignancy-associated, frequently related to acute myelogeneous leukemia; and drug-induced. We present, to the best of our knowledge, the first case of a rotavirus -infection-related Sweet's syndrome. CASE PRESENTATION: An 18-month-old boy of Hellenic origin was referred to us with diarrhea, fever, neutrophilia, typical skin lesions, asymmetrical hip arthritis and oropharyngeal involvement. A skin biopsy confirmed the diagnosis. Thorough screening did not reveal any underlying systemic illness, except for the confirmation of an overt rotavirus infection. The syndrome responded promptly upon corticosteroid administration; no recurrence was observed. CONCLUSION: Besides describing the connection of Sweet's syndrome to a rotavirus infection, this case report is also a reminder that in a child presenting with a febrile papulo-nodular rash with neutrophilia Sweet's syndrome should be included in the differential.

Decisions about referrals for psychological therapies: a matched-patient qualitative study.

BACKGROUND: Psychological therapies are effective treatments for common mental health problems, but access is limited. GPs face difficult decisions as to whom to refer, but little is known about this decision-making process. AIM: To explore GPs' accounts of decisions to refer, or not refer, patients for psychological therapy. DESIGN OF STUDY: A qualitative study, using a matched-patient procedure. SETTING: General practices in two inner London boroughs. METHOD: In semi-structured interviews, GPs were asked to compare and contrast five matched-patient pairs, consisting of patients who had been referred for psychological therapy paired with patients not referred. The interviews were analysed using a general thematic analysis. RESULTS: Fourteen GPs discussed 130 matched patients (65 patient pairs). Three main factors distinguished GPs' accounts of the patients they referred compared with the matched patients they did not refer. These factors were: patient initiative in requesting or showing interest in referral; estimated capacity of the patient to benefit from psychological therapy; and the GP's own capacity to help the patient in terms of skills, expertise, and time. CONCLUSION: GPs gave accounts of themselves acting as rational decision makers, judging how effective they thought a referral would be based on a patient's clinical presentation and motivation, compared with the GPs' own ability to help.

Rising incidence of type 1 diabetes mellitus in children and adolescents in Cyprus in 2000-2004.

INTRODUCTION: The incidence of type 1 diabetes mellitus (T1DM) has dramatically increased recently in some countries. AIM: To ascertain any changes in the incidence of T1DM in our population during the years 1990-2004. METHODOLOGY: All newly diagnosed cases of T1DM children under the age of 15 yr were registered and relevant information was obtained. Population demographic data based on the most recent census were used for calculations. RESULTS: The overall mean annual incidence of T1DM during this 15-yr period was 11.9/100,000 person-years, with a statistically significant increase in the third 5-yr period (14.9/100,000 person-years). The incidence during the first (1990-1994) and second (1995-1999) 5-yr periods was 10.5/100,000 person-years (p < 0.001). The overall male:female ratio was 0.94. Seasonal distribution for the first and second 5-yr periods revealed a higher incidence during winter and autumn months. Seasonal variation, however, disappears in the third 5-yr period, where no differences were found between the four seasons. CONCLUSION: The incidence of newly diagnosed T1DM cases has increased during 2000-2004. A seasonal variation during the first and second 5-yr periods was no longer observed in the third 5-yr period.

Sensitivity and specificity of six tests for the diagnosis of adult GH deficiency.

Although the use of the insulin tolerance test (ITT) for the diagnosis of adult GH deficiency is well established, diagnostic peak GH cut-points for other commonly used GH stimulation tests are less clearly established. Despite that fact, the majority of patients in the United States who are evaluated for GH deficiency do not undergo insulin tolerance testing. The aim of this study was to evaluate the relative utility of six different methods of testing for adult GH deficiency currently used in practice in the United States and to develop diagnostic cut-points for each of these tests. Thirty-nine patients (26 male, 13 female) with adult-onset hypothalamic-pituitary disease and multiple pituitary hormone deficiencies were studied in comparison with age-, sex-, estrogen status-, and body mass index-matched control subjects (n = 34; 20 male, 14 female). A third group of patients (n = 21) with adult-onset hypothalamic-pituitary disease and no more than one additional pituitary hormone deficiency was also studied. The primary end-point was peak serum GH response to five GH stimulation tests administered in random order at five separate visits: ITT, arginine (ARG), levodopa (L-DOPA), ARG plus L-DOPA, and ARG plus GHRH. Serum IGF-I concentrations were also measured on two occasions. For purposes of analysis, patients with multiple pituitary hormone deficiencies were assumed to be GH deficient. Three diagnostic cut-points were calculated for each test to provide optimal separation of multiple pituitary hormone deficient and control subjects according to three criteria: 1) to minimize misclassification of control subjects and deficient patients (balance between high sensitivity and high specificity); 2) to provide 95% sensitivity for GH deficiency; and 3) to provide 95% specificity for GH deficiency. The greatest diagnostic accuracy occurred with the ITT and the ARG plus GHRH test, although patients preferred the latter (P = 0.001). Using peak serum GH cut-points of 5.1 microg/liter for the ITT and 4.1 microg/liter for the ARG plus GHRH test, high sensitivity (96 and 95%, respectively) and specificity (92 and 91%, respectively) for GH deficiency were achieved. To obtain 95% specificity, the peak serum GH cut-points were lower at 3.3 microg/liter and 1.5 microg/liter for the ITT and ARG plus GHRH test, respectively. There was substantial overlap between patients and control subjects for the ARG plus L-DOPA, ARG, and L-DOPA tests, but test-specific cut-points could be defined for all three tests to provide 95% sensitivity for GH deficiency (peak GH cut-points: 1.5, 1.4 and 0.64 microg/liter, respectively). However, 95% specificity could be achieved with the ARG plus L-DOPA and ARG tests only with very low peak GH cut-points (0.25 and 0.21 microg/liter, respectively) and not at all with the L-DOPA test. Although serum IGF-I levels provided less diagnostic discrimination than all five GH stimulation tests, a value below 77.2 microg/liter was 95% specific for GH deficiency. In conclusion, the diagnosis of adult GH deficiency can be made without performing an ITT, provided that test-specific cut-points are used. The ARG plus GHRH test represents an excellent alternative to the ITT for the diagnosis of GH deficiency in adults.

Cardiovascular risk factors in acromegaly before and after normalization of serum IGF-I levels with the GH antagonist pegvisomant.

Acromegaly is associated with premature cardiovascular mortality. GH replacement therapy decreases inflammatory markers of cardiovascular risk, but little is known about these markers in patients with acromegaly. The GH receptor antagonist, pegvisomant, reduces IGF-I levels in 98% of patients treated. We investigated the effects of GH receptor blockade on inflammatory and other cardiovascular risk markers in active acromegaly. Forty-eight patients with acromegaly and 47 age- and body mass index-matched controls were included. The study consisted of 3 parts: a cross-sectional study, a prospective randomized 12-wk placebo-controlled study, and a longitudinal open-label study of up to 18 months of pegvisomant treatment. After baseline evaluation, patients with acromegaly were randomized to placebo (n = 14), 10 mg (n = 12), 15 mg (n = 10), or 20 mg (n = 12) daily pegvisomant for 12 wk. Subsequently, all patients received at least 10 mg pegvisomant daily for up to 18 months, with dose adjustments to achieve a normal IGF-I level. Anthropometry, GH, IGF-I, and pegvisomant levels were measured monthly. C-reactive protein (CRP), IL-6, homocysteine, lipoprotein(a), glucose, insulin, triglycerides, total cholesterol, and high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol were determined at baseline, 4 and 12 wk in the placebo-controlled study and at 3-month intervals (during which IGF-I levels were normal) in the longitudinal study. In the cross-sectional study, patients had lower CRP than did controls [median, 0.3 (range, 0.2-0.8) vs. 2.0 (0.6-3.7) mg/liter; P < 0.0001] and had higher insulin [78.6 (55.8-130.2) vs. 54.5 (36.6-77.5) pM, P = 0.0051]. IL-6, homocysteine, triglycerides, lipoprotein(a), LDL cholesterol and HDL cholesterol were not different between groups. In the placebo-controlled study, CRP increased in patients treated with 20 mg pegvisomant, compared with placebo (mean +/- SEM, 13.7 +/- 3.6 vs. 0.5 +/- 3.3 mg/liter; P = 0.010). There were no significant differences in IL-6, homocysteine, glucose, insulin, triglyceride, total cholesterol, LDL cholesterol and HDL cholesterol levels. In the longitudinal open-label study (median duration, 15.6 months), CRP increased by 2.0 +/- 0.5 mg/liter (P = 0.0002). Total cholesterol and triglycerides increased (0.22 +/- 0.11 mM, P = 0.050; and 0.25 +/- 0.09 mM, P = 0.007, respectively), whereas lipoprotein(a) decreased (-70 +/- 33 mg/liter, P = 0.039). Glucose, insulin, homocysteine, HDL cholesterol, and IL-6 did not change. We conclude that patients with active acromegaly have lower CRP and higher insulin levels than healthy controls. Administration of pegvisomant increases CRP levels. We propose that GH secretory status is an important determinant of serum CRP levels, although additional studies are needed to determine the mechanism and significance of this finding.

The incidence of type 1 diabetes mellitus in Greek-Cypriot children and adolescents in 1990-2000.

OBJECTIVES: To ascertain the exact incidence of type 1 diabetes mellitus (DM1) in Greek-Cypriots under the age of 15 yr, to analyze possible gender differences in the age of onset and to observe any seasonal variation in the manifestation of the disease. RESEARCH DESIGN AND METHODS: All cases of newly diagnosed DM1 patients under the age of 15 yr from 1990 to 2000 were collected and relevant information was obtained. The data were statistically processed in relation to the population data provided by the Department of Statistics and Research of the Ministry of Finance. RESULTS: The mean annual incidence of DM1 in the Greek population of Cyprus under the age of 15 yr for the period 1990-2000 is 11.32/100,000. There is a trend towards increasing incidence during this period. There is a gender influence on the age of onset: more males develop DM1 before the age of 6 yr and after 13 yr. Moreover, there is a gender difference in the group who manifest DM1 in the age range 5-9 yr, with females having a mean age of onset of 8.1 yr, compared with 7.3 yr for males. There is a statistically significant seasonal variation, but not among preschool subjects who manifest DM1 before the age of 4 yr. CONCLUSIONS: DM1 is a common condition in Greek-Cypriots under the age of 15 yr. The gender difference in the age of onset probably reflects the peripubertal period of each gender. The seasonal variation cannot be solely attributed to weather and temperature changes. This survey covers a 10-yr period and deals with an adequate number of reported cases; therefore, it could contribute to the international effort to determine the exact pathogenesis of DM1.