Improving QoS guarantees through implicit AC

http://www2.dcc.ufmg.br/eventos/noms2008/In multiservice networks, admission control (AC) is a convenient means of assuring high quality communications by safeguarding enough availability for customer traffic. This can be particularly useful to preserve the quality of services such as IP telephony and video conferencing, and to ensure acceptable throughput to elastic flows. This paper tackles the problematic of performing implicit AC in multiservice networks, pointing out a flexible yet simple to deploy solution for controlling flows which do not explicitly send signaling admission requests. This allows to complement the explicit AC case, widening the ability to integrate services and applications in a transparent way. The versatility and self-adaptability of the proposed distributed AC criteria in ensuring the quality of multiple services is also proved

A distributed admission control model for CoS networks using QoS and SLS monitoring

Achieving an admission control strategy for CoS networks covering both intra-domain and end-to-end operation is still an open issue. This paper discusses how AC can be carried out without adding significant complexity to the network control plane and proposes a distributed service-oriented AC model for these networks. The model only involves the network edge nodes leaving the network core unchanged. Ingress nodes perform implicit or explicit service-dependent AC based on both QoS and SLSs utilization metrics, obtained through on-line edge-to-edge monitoring performed at egress nodes. From an end-to-end perspective, the flow request is used both for AC and available service computation. Relevant aspects of the model interrelated areas and implementation key points are also discussed

Excess length of hospital stay due to healthcare acquired infections. Methodologies evaluation

BACKGROUND: Healthcare acquired infections (HAI) cause an increase of burden and in particular excess length of hospital stay (LOS) accounts for approximately up to 90% of total costs. Therefore accurate estimation of extra hospital stay due to healthcare acquired infections is very important. METHODS: The authors carried out a review comparing the principal methods internationally used for estimating the excess LOS attributable to healthcare acquired infections. RESULTS: The methods described and analysed are: 1) Implicit physician assessment; 2) appropriateness evaluation protocol; 3) unmatched case-control; 4) matched case-control; 5) regression analysis; 6) multistate model. The various methodologies are described underlining advantages and limits which researchers need to know before starting any economic analysis. CONCLUSIONS: Overall, studies taking into account the time-dependent nature of HAI show to give more precise and reliable results

No Fats, Femmes, or Asians

A frequent caveat in online dating profiles – “No fats, femmes, or Asians” – caused an LGBT activist to complain about the bias against Asians in the American gay community, which he called “racial looksism”. In response, he was asked that, if he himself would not date a fat person, why he should find others not dating Asians so upsetting. This response embodies a popular attitude that personal preferences or tastes are simply personal matters – they are not subject to moral evaluation. In this paper, I argue, against this popular attitude, that a personal preference like racial looksism is indeed wrong. A preference like racial looksism is wrong because it is an overgeneralization that disrespects individuality by treating people as exchangeable tokens of one type, and such disrespect denies its objects appreciation that their dignity entitles them to. As it turns out, there is on my account a relevant moral difference between racial looksism and simple looksism

Temporal Trends in Incidence, Sepsis-Related Mortality, and Hospital-Based Acute Care After Sepsis.

OBJECTIVES: A growing number of patients survive sepsis hospitalizations each year and are at high risk for readmission. However, little is known about temporal trends in hospital-based acute care (emergency department treat-and-release visits and hospital readmission) after sepsis. Our primary objective was to measure temporal trends in sepsis survivorship and hospital-based acute care use in sepsis survivors. In addition, because readmissions after pneumonia are subject to penalty under the national readmission reduction program, we examined whether readmission rates declined after sepsis hospitalizations related to pneumonia. DESIGN AND SETTING: Retrospective, observational cohort study conducted within an academic healthcare system from 2010 to 2015. PATIENTS: We used three validated, claims-based approaches to identify 17,256 sepsis or severe sepsis hospitalizations to examine trends in hospital-based acute care after sepsis. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: From 2010 to 2015, sepsis as a proportion of medical and surgical admissions increased from 3.9% to 9.4%, whereas in-hospital mortality rate for sepsis hospitalizations declined from 24.1% to 14.8%. As a result, the proportion of medical and surgical discharges at-risk for hospital readmission after sepsis increased from 2.7% to 7.8%. Over 6 years, 30-day hospital readmission rates declined modestly, from 26.4% in 2010 to 23.1% in 2015, driven largely by a decline in readmission rates among survivors of nonsevere sepsis, and nonpneumonia sepsis specifically, as the readmission rate of severe sepsis survivors was stable. The modest decline in 30-day readmission rates was offset by an increase in emergency department treat-and-release visits, from 2.8% in 2010 to a peak of 5.4% in 2014. CONCLUSIONS: Owing to increasing incidence and declining mortality, the number of sepsis survivors at risk for hospital readmission rose significantly between 2010 and 2015. The 30-day hospital readmission rates for sepsis declined modestly but were offset by a rise in emergency department treat-and-release visits

Geriatric pharmacotherapy : optimisation through integrated approach in the hospital setting

Since older patients are more vulnerable to adverse drug-related events, there is a need to ensure appropriate prescribing in these patients in order to prevent misuse, overuse and underuse of drugs. Different tools and strategies have been developed to reduce inappropriate prescribing; the available measures can be divided into medication assessment tools, and specific interventions to reduce inappropriate prescribing. Implicit criteria of inappropriate prescribing focus on appropriate dosing, search for drug-drug interactions, and increase adherence. Explicit criteria are consensus-based standards focusing on drugs and diseases and include lists of drugs to avoid in general or lists combining drugs with clinical data. These criteria take into consideration differences between patients, and stand for a medication review, by using a systematic approach. Different types of interventions exist in order to reduce inappropriate prescribing in older patients, such as: educational interventions, computerized decision support systems, pharmacist-based interventions, and geriatric assessment. The effects of these interventions have been studied, sometimes in a multifaceted approach combining different techniques, and all types seem to have positive effects on appropriateness of prescribing. Interdisciplinary teamwork within the integrative pharmaceutical care is important for improving of outcomes and safety of drug therapy. The pharmaceutical care process consists offour steps, which are cyclic for an individual patient. These steps are pharmaceutical anamnesis, medication review, design and follow-up of a pharmaceutical care plan. A standardized approach is necessary for the adequate detection and evaluation of drug-related problems. Furthermore, it is clear that drug therapy should be reviewed in-depth, by having full access to medical records, laboratory values and nursing notes. Although clinical pharmacists perform the pharmaceutical care process to manage the patient’s drug therapy in every day clinical practice, the physician takes the ultimate responsibility for the care of the patient in close collaboration with nurses

Helping Our Students Reach Their Full Potential: The Insidious Consequences of Stereotype Threat

A psychological phenomenon may be a significant cause of academic underachievement by minorities in law school. This phenomenon, called stereotype threat, occurs as a result of the fear of confirming a negative group stereotype (such as African-Americans are not as intelligent as Whites). When subject to this threat — as a consequence of being confronted with environmental or explicit triggers — people do worse in academic settings than they otherwise are capable of doing. In this article, I explore the implications of the research on stereotype threat for law schools and make several recommendations to deal with the threat. There are natural implications for law school admissions, of course. If a portion of our applicant pool is affected by stereotype threat, then we cannot trust the accuracy of the metrics we typically use in law school admissions, i.e., prior academic performance and LSAT scores of law school applicants. Indeed, those credentials actually may under-evaluate the academic potential of these applicants, who are often minority students. This should cause law schools to reevaluate their admissions policies. After students are admitted, law school provides fertile ground within which stereotype threat can flourish. This, of course, means that the performance of minorities in law school — in class, on exams, and in other areas — is likely to be diminished, such that many minorities will not perform up to their academic capacity. And, obviously, we would expect this same dynamic to play out on the bar exam. Law schools can address stereotype threat at each of these levels, and they should do so. This article lays out a framework for understanding and dealing with the threat

Distributed admission control for QoS and SLS management

This article proposes a distributed admission control (AC) model based on on-line monitoring to manage the quality of Internet services and Service Level Specifications (SLSs) in class-based networks. The AC strategy covers intra- and interdomain operation, without adding significant complexity to the network control plane and involving only edge nodes. While ingress nodes perform implicit or explicit AC resorting to service-oriented rules for SLS and QoS parameters control, egress nodes collect service metrics providing them as inputs for AC. The end-to-end operation is viewed as a cumulative and repetitive process of AC and available service computation.We discuss crucial key points of the model implementation and evaluate its two main components: themonitoring process and the AC criteria. The results show that, using proper AC rules and safety margins, service commitments can be efficiently satisfied, and the simplicity and flexibility of the model can be explored to manage successfully QoS requirements of multiple Internet services.(undefined