Energy-efficient traffic engineering

The energy consumption in telecommunication networks is expected to grow considerably, especially in core networks. In this chapter, optimization of energy consumption is approached from two directions. In a first study, multilayer traffic engineering (MLTE) is used to assign energy-efficient paths and logical topology to IP traffic. The relation with traditional capacity optimization is explained, and the MLTE strategy is applied for daily traffic variations. A second study considers the core network below the IP layer, giving a detailed power consumption model. Optical bypass is evaluated as a technique to achieve considerable power savings over per-hop opticalelectronicoptical regeneration. Document type: Part of book or chapter of boo

ЭФФЕКТИВНОСТЬ НОЧНОЙ ИНТУБАЦИИ ПРИ ОПЕРАЦИЯХ ПО ПОВОДУ РАКА ОРГАНОВ ПОЛОСТИ РТА – РЕТРОСПЕКТИВНОЕ ИССЛЕДОВАНИЕ

In the post-operative period of maxillofacial oncological operations, tracheostomy is the most commonly used method for securing the airway. These untoward complications made practitioners choose alternative modalities like submental intubation, but literature support on alternatives to tracheostomy for oral oncologic cases is limited. The aim of this observational study is to ascertain whether the use of overnight intubation is a safer and cost-effective practice and if it can be considered an alternative to tracheostomy.Material and methods. 30 patients, 23 males and 7 females in the age group of 34–80 years who underwent treatment for head and neck cancer with major intraoral resection and a unilateral or bilateral neck dissection were included in the study. The following variables were recorded: age, sex, site of tumour, type of neck dissection, use of mandibulotomy/ mandibulectomy, type of reconstruction, duration of stay in ICU, mean hospital stay and Mallampati classification. Postoperative complications, associated with the airway, if any, were recorded simultaneously.Results. None of the 30 patients required re-intubation nor did they develop any respiratory distress post extubation.Conclusion. The purpose of this study is to raise the conscience of every surgeon to cogitate his/her choice of procedure for his/her patients and advocate the use of overnight intubation, as it is a virtuous alternative to tracheostomy.В послеоперационном периоде у больных со злокачественными новообразованиями челюстно-лицевой области трахеостомия является самым распространенным методом, обеспечивающим проходимость воздушных путей. Осложнения трахеостомии побуждают врачей выбирать альтернативные методы, такие как субментальная интубация трахеи. Литературные данные об альтернативных трахеостомии методах при операциях по поводу опухолей органов полости рта ограничены.Цель исследования – выяснить, является ли использование ночной интубации более безопасной и рентабельной по цене, можно ли считать её альтернативой трахеостомии.Материал и методы. Исследование включало 30 больных раком органов головы и шеи (23 мужчины и 7 женщин) в возрасте 34–80 лет, которым была произведена внутриротовая резекция органов полости рта в большом объеме и односторонняя или двусторонняя шейная диссекция. Учитывались следующие параметры: возраст, пол, локализация опухоли, тип шейной диссекции, применение мандибулотомии/мандибулэктомии, тип реконструкции, продолжительность пребывания в реанимации, среднее время пребывания в больнице и классификация Маллампати. Также велась регистрация послеоперационных осложнений, связанных с обеспечением проходимости дыхательных путей.Результаты. Ни один из 30 пациентов не нуждался в повторной интубации, и у них не возникало каких-либо респираторных дистрессов после экстубации.Заключение. Цель этого исследования заключалось в том, чтобы каждый хирург мог обдумать и взвесить свой выбор процедуры для конкретного больного и выступить в поддержку ночной интубации как эффективной альтернативы трахеостомии

A RISING THREAT – RISK FACTORS AND OUTCOMES RELATED TO INFECTIONS WITH ACINETOBACTER SPECIES

ABSTRACTObjective: Acinetobacter species is an important cause of community as well as nosocomial infections with a high mortality rate. The study was doneto analyze the risk factors associated with Acinetobacter infections and their outcomes.Methods: The clinical details of 100 patients having infections with Acinetobacter species over a period of 1-year were analyzed for underlying riskfactors and outcomes. The antibiotic sensitivity results were interpreted according to the Clinical Laboratory Standards Institute guidelines.Results: Majority of the infections caused by the Acinetobacter species were lower respiratory tract infections, most common being ventilatorassociatedpneumonia. 47% of the isolates were multi drug resistant and 26% were extensively drug resistant. There is a significant chance of drugresistance and a poor outcome with intensive care unit (ICU) stay, prolonged hospital stay of more than 7 days, the presence of 5 or more risk factors.Endotracheal intubation and mechanical ventilation were the risk factors for increased drug resistance in the ICU. Drug resistance was also seen morefrequently in patients with chronic obstructive pulmonary disease, chronic kidney disease, and patients on post-operative care.Conclusion: The steady increase in drug resistant Acinetobacter species and limited antibiotics available advocates an uncompromising approachtoward infection control and a judicious use of antibiotics especially in the ICU. An understanding about the risk factors helps in the appropriateapproach and management of the patient.Keywords: Acinetobacter, Risk factors, Invasive procedures, Nosocomial

Healthcare-Associated Methicillin-Resistant Staphylococcus aureus : Clinical characteristics and antibiotic resistance profile with emphasis on macrolide-lincosamide...

Objectives: Healthcare-associated methicillin-resistant Staphylococcus aureus (MRSA) is a common pathogen worldwide and its multidrug resistance is a major concern. This study aimed to determine the clinical characteristics and antibiotic susceptibility profile of healthcare-associated MRSA with emphasis on resistance to macrolide-lincosamide-streptogramin B (MLSB) phenotypes and vancomycin. Methods: This cross-sectional study was carried out between February 2014 and February 2015 across four tertiary care hospitals in Mangalore, South India. Healthcare-associated infections among 291 inpatients at these hospitals were identified according to the Centers for Disease Control and Prevention guidelines. Clinical specimens were collected based on infection type. S. aureus and MRSA isolates were identified and antibiotic susceptibility tests performed using the Kirby-Bauer disk diffusion method. The minimum inhibitory concentration of vancomycin was determined using the Agar dilution method and inducible clindamycin resistance was detected with a double-disk diffusion test (D-test). Results: Out of 291 healthcare-associated S. aureus cases, 88 were MRSA (30.2%). Of these, 54.6% were skin and soft tissue infections. All of the isolates were susceptible to teicoplanin and linezolid. Four MRSA isolates exhibited intermediate resistance to vancomycin (4.6%). Of the MRSA strains, 10 (11.4%) were constitutive MLSB phenotypes, 31 (35.2%) were inducible MLSBphenotypes and 14 (15.9%) were macrolide-streptogramin B phenotypes. Conclusion: Healthcare-associated MRSA multidrug resistance was alarmingly high. In routine antibiotic susceptibility testing, a D-test should always be performed if an isolate is resistant to erythromycin but susceptible to clindamycin. Determination of the minimum inhibitory concentration of vancomycin is necessary when treating patients with MRSA infections

Human exercise-induced circulating progenitor cell mobilization is nitric oxide-dependent and is blunted in South Asian men

This article is available open access through the publisher’s website. Copyright @ 2010 American Heart Foundation.Objective— Circulating progenitor cells (CPC) have emerged as potential mediators of vascular repair. In experimental models, CPC mobilization is critically dependent on nitric oxide (NO). South Asian ethnicity is associated with reduced CPC. We assessed CPC mobilization in response to exercise in Asian men and examined the role of NO in CPC mobilization per se. Methods and Results— In 15 healthy, white European men and 15 matched South Asian men, CPC mobilization was assessed during moderate-intensity exercise. Brachial artery flow-mediated vasodilatation was used to assess NO bioavailability. To determine the role of NO in CPC mobilization, identical exercise studies were performed during intravenous separate infusions of saline, the NO synthase inhibitor l-NMMA, and norepinephrine.  Flow-mediated vasodilatation (5.8%±0.4% vs 7.9%±0.5%; P=0.002) and CPC mobilization (CD34+/KDR+ 53.2% vs 85.4%; P=0.001; CD133+/CD34+/KDR+ 48.4% vs 73.9%; P=0.05; and CD34+/CD45− 49.3% vs 78.4; P=0.006) was blunted in the South Asian group. CPC mobilization correlated with flow-mediated vasodilatation and l-NMMA significantly reduced exercise-induced CPC mobilization (CD34+/KDR+ −3.3% vs 68.4%; CD133+/CD34+/KDR+ 0.7% vs 71.4%; and CD34+/CD45− −30.5% vs 77.8%; all P<0.001). Conclusion— In humans, NO is critical for CPC mobilization in response to exercise. Reduced NO bioavailability may contribute to imbalance between vascular damage and repair mechanisms in South Asian men.British Heart Foundatio

YALE OBSERVATION SCALE AS A PREDICTOR OF BACTEREMIA AND FINAL OUTCOME IN 3-36 MONTHS OLD FEBRILE CHILDREN ADMITTED IN TERTIARY HEALTH CENTRES: A HOSPITAL-BASED CROSS-SECTIONAL STUDY

ABSTRACTObjectives: The objective of the study was to assess predictability of bacteremia in febrile children in the age group of 3-36 months by application ofYale observation scale (YOS) and to predict clinical course during hospital stay and final outcome by YOS.Methods: A hospital-based cross-sectional study was carried out at Kasturba Medical College, Mangalore, Karnataka, for a period of 2 years(September 2013-September, 2015) in 100 febrile children in the age group of 3-36 months with probable infectious etiology admitted in ward/PICU.Children with any non-infectious causes of fever (vaccination, autoimmune, and immunodeficiency disorder) were excluded from the study. Caseswere selected by simple random sampling. The primary study outcome was bacteremia based on positivity on blood culture and sensitivity sampledrawn at admission. Secondary outcomes are clinical course in the hospital, use of antibiotics, need for mechanical ventilation, hospital stay, andmortality.Results: 100 cases were included in the study out of which 18 cases were bacteremic with a mean YOS of 26 (non-bacteremic - 11), mean hospitalstay 19.5 days (non-bacteremic - 12 days). All 18 bacteremic children had YOS ≥20, but YOS ≥20 had 8 false positives cases. There was no significantinterobserver variability in YOS assessment (Cronbach's alpha - 0.993 showing good correlation with intraclass correlation coefficient - 0.986).Higher YOS scores had good sensitivity, specificity, positive and negative likelihood ratios, and area under curve for prediction of bacteremia atYOS &gt;20 (100%, 90.2%, 10.2, 0.00, and 0.970), need for mechanical ventilation at YOS &gt;21 (100%, 91.7%, 12.04, 0.00, and 0.969), need for scaling upantibiotics at YOS &gt;21 (70.4%, 94.4%, 12.5, 0.31, and 0.822), and mortality at YOS &gt;21 (90.9%, 85.4%, 6.2, 0.106, 0.878).Conclusion: YOS is a good tool to rule out bacteremia and to prognosticate the clinical course at the first visit. This simple scale can be of value inmonitoring admitted patients for deteriorating clinical state and for assessing the need for referral to higher centers for further management.Keywords: Yale observation scale, Bacteremia, Febrile patients

A Map of Update Constraints in Inductive Inference

We investigate how different learning restrictions reduce learning power and how the different restrictions relate to one another. We give a complete map for nine different restrictions both for the cases of complete information learning and set-driven learning. This completes the picture for these well-studied \emph{delayable} learning restrictions. A further insight is gained by different characterizations of \emph{conservative} learning in terms of variants of \emph{cautious} learning. Our analyses greatly benefit from general theorems we give, for example showing that learners with exclusively delayable restrictions can always be assumed total.Comment: fixed a mistake in Theorem 21, result is the sam