SIP-based proactive and adaptive mobility management framework for heterogeneous networks

Abstract In this paper, we present and evaluate the performance of a mobility management system called the Proactive and Adaptive Handover (PAHO) system. PAHO is an application-level approach that uses SIP to manage client-initiated connection handoff across heterogeneous networks based on the IEEE 802.21 framework with designated user/configuration policy. Unlike conventional systems which make sub-optimal decision when managing connection handoff due to limited awareness of the relevant context for the application/service being delivered, PAHO defines proper interface to interact with the application as to determine when and to where the handoff and/or codec switching should take place in the event of network performance degradation. The results showed that using the PAHO approach on an audio/video conferencing session helps reducing the overall handover delay from 10.766 s (on non-PAHO system) down to at least 288 ms, and slowing down the degradation of MOS value throughout the entire experiment in the event of signal degradation as well as network congestion. It is also shown that load balancing among the access points (AP) could be achieved with an improved Information Server (IS). r 2007 Elsevier Ltd. All rights reserved

Diabetic cardiomyopathy is associated with defective myocellular copper regulation and both defects are rectified by divalent copper chelation

BACKGROUND: Heart disease is the leading cause of death in diabetic patients, and defective copper metabolism may play important roles in the pathogenesis of diabetic cardiomyopathy (DCM). The present study sought to determine how myocardial copper status and key copper-proteins might become impaired by diabetes, and how they respond to treatment with the Cu (II)-selective chelator triethylenetetramine (TETA) in DCM. METHODS: Experiments were performed in Wistar rats with streptozotocin (STZ)-induced diabetes with or without TETA treatment. Cardiac function was analyzed in isolated-perfused working hearts, and myocardial total copper content measured by particle-induced x-ray emission spectroscopy (PIXE) coupled with Rutherford backscattering spectrometry (RBS). Quantitative expression (mRNA and protein) and/or activity of key proteins that mediate LV-tissue-copper binding and transport, were analyzed by combined RT-qPCR, western blotting, immunofluorescence microscopy, and enzyme activity assays. Statistical analysis was performed using Student’s t-tests or ANOVA and p-values of < 0.05 have been considered significant. RESULTS: Left-ventricular (LV) copper levels and function were severely depressed in rats following 16-weeks’ diabetes, but both were unexpectedly normalized 8-weeks after treatment with TETA was instituted. Localized myocardial copper deficiency was accompanied by decreased expression and increased polymerization of the copper-responsive transition-metal-binding metallothionein proteins (MT1/MT2), consistent with impaired anti-oxidant defences and elevated susceptibility to pro-oxidant stress. Levels of the high-affinity copper transporter-1 (CTR1) were depressed in diabetes, consistent with impaired membrane copper uptake, and were not modified by TETA which, contrastingly, renormalized myocardial copper and increased levels and cell-membrane localization of the low-affinity copper transporter-2 (CTR2). Diabetes also lowered indexes of intracellular (IC) copper delivery via the copper chaperone for superoxide dismutase (CCS) to its target cuproenzyme, superoxide dismutase-1 (SOD1): this pathway was rectified by TETA treatment, which normalized SOD1 activity with consequent bolstering of anti-oxidant defenses. Furthermore, diabetes depressed levels of additional intracellular copper-transporting proteins, including antioxidant-protein-1 (ATOX1) and copper-transporting-ATPase-2 (ATP7B), whereas TETA elevated copper-transporting-ATPase-1 (ATP7A). CONCLUSIONS: Myocardial copper deficiency and defective cellular copper transport/trafficking are revealed as key molecular defects underlying LV impairment in diabetes, and TETA-mediated restoration of copper regulation provides a potential new class of therapeutic molecules for DCM

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

SIP-based proactive and adaptive mobility management framework for heterogeneous networks

In this paper, we present and evaluate the performance of a mobility management system called the Proactive and Adaptive Handover (PAHO) system. PAHO is an application-level approach that uses SIP to manage client-initiated connection handoff across heterogeneous networks based on the IEEE 802.21 framework with designated user/configuration policy. Unlike conventional systems which make sub-optimal decision when managing connection handoff due to limited awareness of the relevant context for the application/service being delivered, PAHO defines proper interface to interact with the application as to determine when and to where the handoff and/or codec switching should take place in the event of network performance degradation. The results showed that using the PAHO approach on an audio/video conferencing session helps reducing the overall handover delay from 10.766s (on non-PAHO system) down to at least 288ms, and slowing down the degradation of MOS value throughout the entire experiment in the event of signal degradation as well as network congestion. It is also shown that load balancing among the access points (AP) could be achieved with an improved Information Server (IS). (C) 2007 Elsevier Ltd. All rights reserved

A conservative approach to adaptive call admission control for QoS provisioning in multimedia wireless networks

In this paper, we propose a framework called conservative and adaptive quality of service (CAQoS) to perform the quality of service (QoS) provisioning on both real-time and non real-time traffic in the wireless network. Unlike most conventional schemes which gradually scale-down the bandwidth rates of ongoing connections to accommodate new connection/handoff requests, CAQoS introduces an early scaling-down of bandwidth for new connections based on designated provisioning model. The objectives of CAQoS are to minimize the need for frequent bandwidth reallocation and to achieve lower call blocking and handoff dropping rates, while maximizing the overall bandwidth utilization. The performance of CAQoS system is evaluated through simulations of a realistic wireless cellular-based environment. Simulation results showed that CAQoS met our objectives and outperformed the conventional schemes. (c) 2006 Elsevier B.V. All rights reserved

Diabetes-induced alterations in tissue collagen and carboxymethyllsine in rat kidneys: Association with increased collagent-degrading proteinases and amelioration by Cu(II)-slective chelation

AbstractAdvanced glycation end-products (AGEs) comprise a group of non-enzymatic post-translational modifications of proteins and are elevated in diabetic tissues. AGE-modification impairs the digestibility of collagen in vitro but little is known about its relation to collagen-degrading proteinases in vivo. Nε-carboxymethyllysine (CML) is a stable AGE that forms on lysyl side-chains in the presence of glucose, probably via a transition metal-catalysed mechanism.Here, rats with streptozotocin-induced diabetes and non-diabetic controls were treated for 8weeks with placebo or the Cu(II)-selective chelator, triethylenetetramine (TETA), commencing 8weeks after disease induction. Actions of diabetes and drug treatment were measured on collagen and collagen-degrading proteinases in kidney tissue.The digestibility and CML content of collagen, and corresponding levels of mRNAs and collagen, were related to changes in collagen-degrading-proteinases. Collagen-degrading proteinases, cathepsin L (CTSL) and matrix metalloproteinase-2 (MMP-2) were increased in diabetic rats. CTSL-levels correlated strongly and positively with increased collagen-CML levels and inversely with decreased collagen digestibility in diabetes. The collagen-rich mesangium displayed a strong increase of CTSL in diabetes. TETA treatment normalised kidney collagen content and partially normalised levels of CML and CTSL.These data provide evidence for an adaptive proteinase response in diabetic kidneys, affected by excessive collagen-CML formation and decreased collagen digestibility. The normalisation of collagen and partial normalisation of CML- and CTSL-levels by TETA treatment supports the involvement of Cu(II) in CML formation and altered collagen metabolism in diabetic kidneys. Cu(II)-chelation by TETA may represent a treatment option to rectify collagen metabolism in diabetes independent of alterations in blood glucose levels